1 HZS C2BRNE DIARY – October 2020

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HZS C2BRNE DIARY– 2020© October 2020

Website: www.cbrne-terrorism-newsletter.com

Editor-in-Chief BrigGEN (ret.) Ioannis Galatas MD, MSc, MC (Army) PhD cand Consultant in Allergy & Clinical Immunology Medical/Hospital CBRNE Planner & Instructor Senior Asymmetric Threats Analyst Manager, CBRN Knowledge Center @ International CBRNE Institute (BE) Senior CBRN Consultant @ HotZone Solutions Group (NL) Athens, Greece

 Contact e-mail: [email protected]

Editorial Team ⚫ Bellanca Giada, MD, MSc (Italy) ⚫ Hopmeier Michael, BSc/MSc MechEngin (USA) ⚫ Kiourktsoglou George, BSc, Dipl, MSc, MBA, PhD (UK) ⚫ Photiou Steve, MD, MSc EmDisaster (Italy) ⚫ Tarlow Peter, PhD Sociol (USA)

A publication of HotZone Solutions Group Prinsessegracht 6, 2514 AN, The Hague, The Netherlands T: +31 70 262 97 04, F: +31 (0) 87 784 68 26 E-mail: [email protected]

DISCLAIMER: The HZS C2BRNE DIARY® (former CBRNE-Terrorism Newsletter), is a free online publication for the fellow civilian/military CBRNE First Responders worldwide. The Diary is a collection of papers/articles related to the stated thematology. Relevant sources/authors are included and all info provided herein is from open Internet sources. Opinions and comments from the Editor, the Editorial Team or the authors publishing in the Diary do not necessarily represent those of the HotZone Solutions Group (NL) or the International CBRNE Institute (BE).

COVER: UAE-based gynaecologist Dr Samer Cheaib shared the image which reveals the new child along with her hand clasped round her physician’s masks, pulling it off his smiling face. The caption given by Dr Cheaib reads, “We all want (a) sign are we going to take off the mask soon (?)”

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Editorial Brig Gen (ret.) Ioannis Galatas, MD, MSc, MC (Army)

Editor-in-Chief HZS C2BRNE Diary

Dear Colleagues,

Month #10 and the beast is still alive! Some (many) thought that it would be easy; something like what we knew (flu) so far. Well, it is not. Almost daily we read about new death records in more than one country around the globe. Of course, if we paid similar attention to annual seasonal flu hecatombs humanity would have been more familiar with viral epidemics or pandemics. But the most important of all is the fact that we should have been better prepared for the 2020 Covid-19 pandemic. We were not. We are not – even when the period between the first and the second waves gave us the opportunity to fill some gaps and revise our plans. The only thing we did is to get to know the novel virus a bit better but still, the virus enjoys to surprise us with new offensive modus operandi and adverse effects on the human body. I said it before and I will repeat it one more time. There has to be a brain in every virus or a viral mother brain group of cells in every human organism attacked that guides all the incoming viruses on what to do and where to go. Something like the mother spacecraft during alien invention seen on the movies!

The vaccine race is on although we already have a (Russian Sputnik) winner but the West is constantly changing the rules until our runners are back in the race and game. Because life is a game for some! Similar conditions in the antibody, antiviral, cytokine races with some promising results but not with the one that could make the difference. In this Viral Olympiad we were happy to watch the US President be a corona-winner with a new world recovery record although there is the suspicion that he was dopped. But who can ask for a dope testing of a President? Nevertheless, he promised to give the (American) people his secret recovery medication for free. To those that will combine his noble action with coming elections I contempt to comment. By the way, the 8 million US cases’ burden belongs to the past … and so are the 40 million cases on Planet Earth.

Ten months now and we still do not know (?) when to use the rapid antibody tests available worldwide! It seems that we are not as clever as we thought and that we need a lot of time in order to decide that molecular tests and antibody tests are not rivals because they target two different things – the presence of the virus itself AND the response of the human body exposed to the virus! If the virus had a brain then it would be dead by now because of endless laughter!

Ten months and we still do not know if there is immunity to the virus and if there is for how many months. Initially, it was for 3 months; then for 8 months; then we had some cases of re-infection of previously infected individuals; and now a new study (University of Montreal, Canada) revealed that plasma neutralization activity continues decreasing past the sixth week of symptom onset and so are the antibodies provided to the Covid 19 patients. Ups and downs of hope is as hazardous as the virus itself!

People continue to behave in a strange way convinced that there is no tomorrow and because of that they have to party in all possible ways and occasions. Superspreading is the new normal and people compete which group will contaminate more! It is also a good opportunity for a variety of diagnoses from experts and gov officials ranging from evolution related deficiencies (referring to those younger than 18 years old) all the way to modern anxiety status and capitalism. Nobody dears to speak out loud that too much freedom is, at the end, bad for our health. “All in good measure” an ancient Greek quota (“παν μέτρον άριστον”) has been forgotten globally – it is OK for those living in Peru or Vietnam; but not for Greeks and other more educated (?) nations. The ongoing pandemic is a good opportunity to redefine “individual democratic limits” that confuse people or minorities.

Covid-19 is one plague; Turkey is another! Spreading in the SE Mediterranean region and Central Asia is causing problems to the level of a regional war! The EU-US apathy is combined with an “empire” ambition and the mixture might be highly explosive. It is heartbreaking to watch strong nations to bow to a bully just because they are doing business

www.cbrne-terrorism-newsletter.com 5 HZS C2BRNE DIARY – October 2020 with him or because he happens to live at a crossroad necessary for their ambitions (mainly anti-Russian and oil/gas related). In addition, it is a fine example of solidarity between Muslim nations (Azerbaijan is actively supported by Turkey and Pakistan) compared to the no support provided within Western nations. On the other hand, it is a powerful lesson to everybody that in good things we are all together but in bad things you are alone. Nothing new you might say along with the fact that history repeats itself.

The remaining two months before 2021 will be very interesting especially if we do have the good Western vaccine for the virus and if a conflict or war between Turkey and Greece is avoided (Galip Dalay @ Robert Bosch Academy) – because obedience and civilized behavior has its limits.

Take care First Responders! The pandemic is not that bad if we all understand the new norms (masks; distances; hygiene) and act accordingly. Help people play defense and reassure them that this is the right tactic to win critical games!

The Editor-in-Chief

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Birds in San Francisco Started Singing Differently in The Silence of COVID-19 Lockdown Source: https://www.sciencealert.com/sparrows-have-changed-behaviour-in-response-to-coronavirus-anthropaus

Sep 25 – As the streets of San Francisco emptied out in the first months of the pandemic, the city's male birds began singing more softly and improving their vocal range, making them "sexier" to females, according to a new study published Thursday. The paper adds to a growing body of research describing how animals - from whales to coyotes to the white-crowned sparrow studied here - have adapted their behaviors to COVID-19 shutdowns that forced humans to retreat to their homes, a phenomenon dubbed the "anthropause." "When the city was loud, they were singing really loudly," Elizabeth Derryberry, a behavioral ecologist at the University of Tennessee, who led the study published in Science, told AFP. But as traffic ground to a halt following a statewide shelter-in-place order in spring, noise levels fell by 50 percent, she said. The number of vehicles on the Golden Gate Bridge collapsed to 1954 levels, the researchers found. They compared birdsong data they had collected from previous years to recordings made at the same sites from April to May 2020, finding the sparrows were now singing far more quietly, and were able to hit much lower notes, which in turn expanded their range and enhanced their overall performance. Imagine going to a party at a friend's house: at the start of the night you speak at a normal volume, but as the place fills up you have to raise your voice to be heard. "When you're shouting at a cocktail party, your voice is not at its best," said Derryberry, adding that it was similar for birds.

As noise pollution decreased, "their songs also sounded better, they sounded sexier," she said. "They were better competitors, and they sounded like better mates to females." The scientists were surprised by just how far the volume of their songs had dropped - almost a third.

But despite this, the sparrows' trills could still be heard from twice as far away compared to before the shutdown, tying in with anecdotal reports of birdsongs becoming more conspicuous to humans. The authors said their research showed just how quickly birds can adapt to changing environments, and suggest that finding long-term solutions to curbing

noise pollution might lead to other positive outcomes like higher species diversity.

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Europe Out of the Loop in New Middle East By Jonathan Spyer Source: https://www.meforum.org/61569/europe-and-the-new-middle-east

Sep 22 – In the capitals of Europe, there is as yet only limited understanding of the new and emergent strategic realities of the Middle East. As a result, European countries are increasingly irrelevant or invisible in the diplomacy of the region. The still dominant perspectives in Europe belong largely to the era now fading: the supposed centrality of the Israeli-Palestinian conflict to Mideast stability, the desire to return to the Iran nuclear agreement, a more general preference for formal and multi-lateral agreements, while the region favours the tacit, the pragmatic and the bilateral. As a result, European countries have played no part in the emergence and crystallization of the tacit alliance of pro-Western countries of which Israel and the UAE form a part. This alliance has emerged through bilateral connections, but with the quiet encouragement and tutelage of the US. Similarly, the US policy of maximum pressure on Iran, strongly supported by pro-Western regional states, is opposed by key European countries. They favour a return to the JCPOA. In so doing, again, Europe will advance not its interests, but rather its irrelevance. On the issue of Turkish aggression in the Eastern Mediterranean, France and Greece are playing a vital role. No united European stance has been forthcoming, however. Italy, one of the EU's other leading powers sits on the opposite side to France, remaining aligned with Turkey. The fear of President Erdogan's use of Syrian migrants as a tool of intimidation apparently remains.

Jonathan Spyer is director of the Middle East Center for Reporting and Analysis and a Ginsburg/Milstein Writing Fellow at the Middle East Forum.

Dogs Deployed at Helsinki Airport Can Detect COVID-19 With Almost 100% Accuracy Source: https://www.sciencealert.com/dogs-deployed-at-helsinki-airport-can-detect-covid-19-with-near-perfect-accuracy

Sep 25 – Passengers alighting at Helsinki Airport in Finland starting from earlier this week will have a speedier - and much fuzzier - way of getting tested for COVID-19.

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A team of dogs has been deployed to fill their snoots with eau d'arriving passenger to sniff out those infected with the virus behind the current global pandemic. If successful, the pilot scheme could help provide a more efficient method of detection that could be used in a range of scenarios. "We are among the pioneers," said airport director Ulla Lettijeff of aviation company Finavia. "As far as we know no other airport has attempted to use canine scent detection on such a large scale against COVID-19. We are pleased with the city of Vantaa's initiative. This might be an additional step forward on the way to beating COVID-19." For people with allergies, or fear of dogs, there's no reason to worry. The passengers will have no direct contact with the canine COVID-19 detectives. The test is performed from a wipe that is swiped on the passenger's skin, and placed in a cup. In a separate booth, the dog will sniff the sample. If the dog detects COVID-19, they will make a physical sign. Why the dogs can detect the virus is not entirely clear. However, a recent French study found that dogs trained to smell the difference between armpit sweat from healthy people and those with COVID-19 could do so with 95 percent certainty. Another recent German study found that dogs trained to do the same with saliva samples could detect COVID-19 with 94 percent accuracy. And researchers at the Veterinary Faculty of the University of Helsinki say their dogs could detect COVID-19 with a similar level of certainty - "almost 100 percent", according to Finavia's announcement of the scheme. "This research has exceeded our expectations," veterinarian Anna Hielm-Björkman of the University of Helsinki told national broadcaster Yle. "The dogs have identified cancer and other diseases in the past, but we have been surprised at how much easier it is for the dogs to spot corona." But it's not just the accuracy that matters here. There's the speed of the test; with a laboratory test, results take some time. Dogs can also detect the virus sooner than laboratory tests, days before symptoms appear. And they require a much smaller sample - 10 to 100 molecules, as opposed to the 18 million required for laboratory tests, Finavia said. Passengers for whom the dogs indicate a positive result will be directed to a health information point located in the airport. Ten dogs are being trained for the task, all of whom have had previous scent detection experience. Each shift will consist of four dogs. "Dogs need to rest from time to time," said Susanna Paavilainen of WiseNose, a company that specialises in training scent detection dogs. "While two dogs are working, the other two are on a break. The service is mainly intended for passengers arriving from outside the country." The dogs themselves should be safe. Dogs can test positive to COVID-19, but, according to a study from May of this year, it seems to pose them no health hazards, and don't seem able to transmit the virus to other animals. The pilot program, according to The Guardian, is scheduled to run for four months, after which the results will be assessed. If it goes well, sniffer dogs may eventually replace the humans currently testing incoming passengers for the coronavirus. Meanwhile, Finland is not the only country riding the dog train. Other countries, such as Saudi Arabia, France, Chile, Australia and Brazil are also investigating the employment of scent detection dogs for faster, safer detection of COVID-19.

Seven detained after knife attack near ex-Charlie Hebdo offices Source: https://www.bbc.com/news/world-europe-54302337

Sep 26 – Seven people have been detained in connection with an attack outside the former offices of satirical magazine Charlie Hebdo in Paris, officials say. A man armed with a meat cleaver wounded two people in the attack on Friday. The main suspect, identified as an 18-year-old man of Pakistani origin, was arrested near the scene. Police said six others were in custody and being questioned. The attack is being treated as a terrorist incident. Interior Minister Gérald Darmanin said it was "clearly an act of Islamist terrorism". He said police had underestimated the threat level in the area. The attack came as a high-profile trial was under way of 14 people accused of helping two jihadists carry out the 2015 attack on Charlie Hebdo, in which 12 people were killed.

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Charlie Hebdo vacated its offices after the 2015 attack, and the b uilding is now used by a television production company. The two victims of Friday's attack have not been officially named but police said they were a man and woman who worked at the production company. Prime Minister Jean Castex told reporters at the scene - near Boulevard Richard- Lenoir - that their lives were not in danger. Charlie Hebdo is now run from a secret location.

What do officials say happened? In an interview with state broadcaster France 2 late on Friday, Mr Darmanin described the stabbing as "a new bloody attack against our country, against journalists". "It's the street where Charlie Hebdo used to be. This is the way the Islamist terrorists operate," the interior minister said. He said he had ordered security to be stepped up around synagogues this weekend for Yom Kippur, the holiest day in the Jewish calendar. The main suspect has not been named, but Mr Darmanin said he arrived in the country three years ago "as an isolated minor" of Pakistani nationality. The minister added that the suspect was not known for being radicalised, but had a previous arrest for carrying a screwdriver - and gave no details.

How did the attack unfold? Colleagues of the victims said they had been outside the Premieres Lignes news production agency smoking a cigarette when they were attacked. The firm has offices Rue Nicolas Appert, a street off Boulevard Richard-Lenoir where Charlie Hebdo's offices used to be located. A mural honouring those killed in the January 2015 attack is nearby. "I went to the window and saw a colleague, bloodied, being chased by a man with a machete," one employee, who asked not to be named, said.

A local trader, who took this photo of a victim being treated, said there was panic outside his store ( EVN/David Cohen)

"They were both very badly wounded," Paul Moreira, the founder and co-head of Premieres Lignes, told AFP news agency. Police quickly sealed off the area and a blade - described as a machete or a meat cleaver - was recovered nearby. The main suspect was arrested on the nearby Place de la Bastille. Shortly afterwards a 33- year-old Algerian national was also taken into custody over possible links to the attack.

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Five others - born between 1983 and 1996 and said to be of Pakistani origin - were later detained during the search of property north of Paris believed to be the home of the main suspect, officials say. In a tweet, Charlie Hebdo expressed its "support and solidarity with its former neighbours... and the people affected by this odious attack".

What about the new trial? Charlie Hebdo marked the start of the trial earlier this month by reprinting its controversial cartoons of the Prophet Muhammad. The original cartoons had sparked anger and protests in several Muslim majority countries. In response to the reprinting, the militant group al-Qaeda - which claimed the 2015 attack - renewed its threat against the magazine. The magazine's head of human resources said earlier this week that she had moved out of her home after receiving death threats. The defendants are also accused of helping another jihadist carry out related attacks, killing four people. The 17 victims were killed over a period of three days. All three attackers were killed by police. The killings marked the beginning of a wave of jihadist attacks across France that left more than 250 people dead.

What happened in 2015? On 7 January that year, two French Muslim gunmen - brothers Chérif and Saïd Kouachi - stormed the Charlie Hebdo offices Rue Nicolas-Appert before opening fire on its staff.

The editor, Stéphane Charbonnier, better known as Charb, was among four celebrated cartoonists who were killed. The gunmen were eventually killed by security forces after a manhunt. Their victims were eight journalists, two police officers, a caretaker and a visitor. In a related attack just days later, jihadist gunman Amedy Coulibaly killed three customers and an employee in a hostage siege at the Hyper Cacher Jewish supermarket in the east of Paris. He had earlier shot dead a policewoman in the city. Security forces eventually stormed the supermarket before killing him and freeing the remaining hostages.

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Extremism, Displacement, and COVID-19 in the Sahel and Lake Chad Basin – Burkina Faso Source: https://reliefweb.int/report/burkina-faso/extremism-displacement-and-covid-19-sahel-and-lake-chad-basin

Sep 27 – While the world struggles to address the challenges presented by the COVID-19 pandemic, many vulnerable populations are combatting cross-cutting threats to their livelihood, peace, and security. A stark example is in the Sahel and Lake Chad Basin regions of Africa, where attacks by violent extremist groups have persisted since March. Violence in these regions is having major effects and presenting challenges for the already overburdened network of camps and informal settlements across the continent.

Extremist Violence and Displacement The effects of the pandemic on conflict in the Sahel and Lake Chad Basin are varied. Early in the pandemic, warnings were raised that groups like al-Qaeda, al-Shabaab, and the Islamic State (ISIS) would use it to further their agendas and make calculated advances. While the frequency of attacks has not dramatically increased, extremist groups’ patterns of violence, cross border movement, and strategic strikes have contributed to an exacerbation of negative displacement trends in the Sahel and Lake Chad Basin. In the Lake Chad Basin, conflicts in northwest Nigeria are drawing interest from both ISIS and al-Qaeda abettors in the Sahel. Images released by the Islamic State West Africa Province (ISWAP), for example, show the group carrying out recruitment missions across the Lake Chad Basin Region. The al-Qaeda affiliate group Jamaat Nusrat al-Islam wal- Muslimeen (JNIM), based in Mali, has also increased its cross-border operations. Already destabilized by armed conflict, and with governments and peace operations diverting their attention to pressing public health needs, these actions by extremist groups are not being met with the force necessary to contain them. The impact of these activities on displacement is concerning. In Burkina Faso, 25,000 Malian refugees were targeted by armed groups in April 2020, leading to a major flow of refugees back into Mali. As of June, 921,000 people were forced to flee from Burkina Faso (a 92 percent increase since 2019). In Niger, a major regional host of refugees and asylum seekers, a series of terrorist attacks forced 489,000 people to flee (including Nigerian and Malian refugees). In Mali, the number of internally displaced people (IDPs) was reported to be nearly 240,000 as of June 2020. Existing conflict and governance related issues—which have forced over 25 million people to be forcibly displaced across Africa—have made the pandemic’s impact worse, exemplified by the location of refugee and IDP camps. Many of these camps are in border areas which adds a layer of health risk to all cross-border movement during the pandemic. The three-

www.cbrne-terrorism-newsletter.com 13 HZS C2BRNE DIARY – October 2020 border area shared by Mali, Burkina Faso, and Niger is just one site of special concern. For instance, despite efforts by Niger authorities, borders remain porous due to long-standing ethnic and economic ties. As a result, Malian refugees continue to regularly traveling back and forth. At the same time, military operations carried out by the Group of Five Sahel (FC-G5 Sahel) and the French operation Barkhane are seeking to push armed extremists back in this region. However, governance-related issues and conflict have made the necessary political solutions that could curtail extremist group’s activities difficult to implement. These events are causing displaced persons to settle in camps that were already under-equipped to provide healthcare and are now dealing with COVID-19. Some camps are host to tens of thousands of people, making social distancing in line with mitigation protocols near impossible. While some formal camps, for instance those operated by the National Emergency Management Agency in Nigeria, are making efforts to ensure regular COVID testing, many camps in the Lake Chad Basin and the Sahel lack the capacity to do so. Compounding the above challenges is that those displaced also face mobility issues. Border closures and temporary halts on asylum claims have severe consequences for those attempting to flee conflict zones, both in Africa and elsewhere. Uganda, host to 1.4 million refugees, announced regulations for asylum seekers, including a suspension of the reception of new asylum seekers. In Italy, immigration offices have been reassigned to carry out pandemic-related duties. While these actions are being taken as precautionary measures, they pose a serious threat to the international right to seek asylum.

Responses and Role of the African Union UN entities, international and regional organizations, and the African Union, have all taken at least initial steps to respond to these challenges, though with some complications. For example, the UN Refugee Agency (UNHCR) and its partners across Africa have responded, but these organizations are economically overstretched and are operating within pandemic-related restrictions, such as border closures, that complicate their mandates. Another example is the International Organization for Migration (IOM) which has been monitoring the pandemic’s effect on displaced populations closely and has been filling in some key capacity gaps. In Bakassi camp in Nigeria, they helped facilitate the movement of an IDP with COVID-19 to an isolation center to curb transmission. IOM has also built self-quarantine units in the displacement camps of Gwoza and Pulka. The African Union’s Peace and Security Council (AUPSC) has called particular attention to the issues being faced by refugees and IDPs during the COVID-19 pandemic, outlining next steps for national, regional, and international actors. The AUPSC noted in April the strong negative impact COVID-19 will have on refugees and IDPs. Other responses have come from the African Commission on Human and Peoples Rights and through a leadership meeting attended by the head of the UN Office for West Africa and the Sahel (UNOWAS), the Lake Chad Basin Commission secretariat, the head of the Multinational Joint Task Force, and the Regional UN Sustainable Development Group. While these are positive steps, responding to extremist violence and displacement-related issues will depend on decisiveness and more significant coordination at the regional and continental level. To this end, there are a few next steps that can be taken by the AU and its member states to mitigate harm.

Ceasefire and Long-Term Planning As ongoing armed conflict exacerbates displacement on the continent, it is crucial that all relevant parties commit to continuing the global ceasefire called by UN Secretary-General Antonio Guterres, and AU Commission chairperson Moussa Faki Mahamat. In terms of planning, regional actors have been responding to the security and humanitarian concerns raised by the complicated landscape for some time. The Economic Community of West African States (ECOWAS) developed a 2020-2024 action plan to end terrorism in January which has the potential to guide some necessary political responses to mitigate extremist groups effectiveness in the long-term. Additionally, consultations between experts of the Lake Chad Basin Commission (LCGC) and the African Union Commission (AUC) resulted in a comprehensive Regional Strategy (the Regional Stabilization, Recovery and Resilience Strategy for Areas Affected by Boko Haram in the Lake Chad Basin Region). It is imperative that international partners support these initiatives as the destabilizing effects of extremism in both the Sahel and Lake Chad Basin regions cannot be curtailed with military intervention alone. At the same time, the AU should continue to prioritize regional political cooperation, which will be critical for long-term stability.

Borders The issues around borders are of particular concern since the movement of people and necessary goods and supplies pose COVID-19 related risks, however borders must not be closed to those seeking asylum. The AU, UNHCR, IOM, and governments should work together to establish protocols that protect civilians from increased COVID-19 transmissions

www.cbrne-terrorism-newsletter.com 14 HZS C2BRNE DIARY – October 2020 and limit unchecked border movement that contributes to human trafficking, smuggling, and transnational crime, while ensuring the rights of asylum seekers is taken into consideration. Governments can provide support by equipping border authorities with the necessary tools to augment COVID-19 preparedness— e.g., by screening travelers—while also developing new solutions to border issues, such as the border assessment and border authorities training program taking place in Mali.

Healthcare COVID-19 poses a host of novel challenges and governments should respond to these challenges by ensuring that all people, especially the ones belonging to the most vulnerable groups, are protected. In this regard, national health services being accessible to both nationals and refugees is essential, and security forces temporarily suspending rotations and prioritizing medical care on military bases will help curtail outbreaks. With the precarious conditions of many refugee camps, the International Committee of the Red Cross (ICRC) and continental entities such as the Nigerian Red Cross can play a significant role in supporting measures that can respond to a possible large-scale outbreak. The challenges of displacement and extremism in sub-Saharan Africa are not novel, but the COVID-19 pandemic is exacerbating them and exposing operational weaknesses in response. If COVID-19 is an “existential serious threat to international peace and security” as stated by the AUPSC, it will require comprehensive and cooperative response that ensures those in need of protection are protected.

Ilhan Dahir is an intern in the Center for Peace Operations at the International Peace Institute. Her research focuses on migration, human rights, and extremism.

What’s the Conflict Between Greece and Turkey All About? By Brandon Turbeville

Sep 29 – With Recep Tayyip Erdogan’s neo-Ottoman desires at the forefront, Turkey is expanding its national borders, with what Erdogan seems to believe will resurrect the Ottoman Empire. From Iraq to Syria and Libya, Turkey has attempted to either gain territory or forcefully make a seat at the international table through military action.

Brandon Turbeville is the author of ten books, Codex Alimentarius — The End of Health Freedom, 7 Real Conspiracies, Five Sense Solutions and Dispatches From a Dissident, volume 1 and volume 2, The Road to Damascus: The Anglo- American Assault on Syria, The Difference It Makes: 36 Reasons Why Hillary Clinton Should Never Be President, and Resisting The Empire: The Plan To Destroy Syria And How The Future Of The World Depends On The Outcome.

COVID-19 and Illicit Trade: When Organized Crime and Terrorists Profit from the Pandemic By Hernan Albamonte Source: https://www.hstoday.us/subject-matter-areas/counterterrorism/covid-19-and-illicit-trade-when-organized-crime-and-terrorists-profit-from- the-pandemic/

Sep 27 – The global COVID-19 pandemic has tragically impacted the lives, health and wellbeing of many around the world. It has led to deep economic recessions, compounded business losses, increased unemployment and reduced consumer incomes. Often overlooked is the fact that the dire impacts of COVID are being worsened by illicitly traded goods such as fraudulent personal protective equipment (PPE). Transnational criminal organizations and global terror groups use illicit trade to facilitate crimes in local communities, disrupting civil society and cultivating corruption. The pandemic is a new business opportunity to finance their nefarious activities.

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Global Impact of Illicit Trade With or without a pandemic, the illegal global trade continues to grow. According to the World Economic Forum, $2.2 trillion will be lost due to diversions of illicit trade funds in 2020. The illicit trade economy is equivalent to the economies of Mexico and Indonesia combined, and dwarfs those of Brazil, Italy and Canada. COVID-19 lockdown restrictions have boosted the key drivers of illicit trade: • Scarcity of goods, mainly PPE, medicines and hand sanitizer; • Loss of revenues due to overall reduced sales; • Economic pressure from loss of income; • Dependence on organized crime as a lender of last resort; and • Limited capacity for enforcement as state resources are reallocated to address the pandemic Criminals have been quick to capitalize on these opportunities, perpetuating illicit activity when governments, industry and the general public are most vulnerable.

Criminal Networks Quickly Adapt to Profit During the Pandemic The pandemic has also exposed weaknesses in governing structures. Across the world, when criminal groups have stepped in to deliver real aid packages and other necessities, they do so with the sole intent of currying political capital and favor from the public to exert further control over communities. In some cases, the pandemic has constrained the illicit activities of organized criminal networks. However, this has been more than offset by bad actors with more structured and complex foundations using the crisis as an opportunity to strengthen their control of illegal markets and territories. Groups have used the crisis to supply markets with illicit services and products that are in high demand during the pandemic. These include substandard and falsified face masks, disinfectants and medicines associated with COVID-19.

Astounding Growth in E-Commerce Globally, the shift to e-commerce over the past decade has been immense and COVID-19 has greatly accelerated the shift from brick and mortar stores. According to eMarketer, global e-commerce sales grew from $1.3 trillion in 2014 to over $4.2 trillion in 2020. E-commerce is projected to accelerate with sales expected to surpass $6.5 trillion by 2023. As people are spending more time online, the attack vectors have increased and various types of cyber-attacks, fraud schemes and other activities are being launched by these criminals. A lot of these goods are offered on online marketplaces we use every day, which have made it easier and cheaper for counterfeiters and other criminals to access a broad customer base. Creating virtual and obscuring real identities is easier online than in offline interactions, which significantly aids criminals using aliases and creating front companies on the web. Recently, the U.S. Department of Justice (DOJ) seized $2 million worth of cryptocurrency from members of ISIS. This network sold counterfeit masks and other PPE, with the goal of turning their profits into cryptocurrency to buy weapons. This is another clear example of how criminals and terrorist groups are taking advantage of the pandemic with counterfeit goods and using online marketplaces to conceal nefarious sellers. They were quick to adapt after years of trading in other illicit forms. “The complaint highlights a scheme by Murat Cakar, an ISIS facilitator who is responsible for managing select ISIS hacking operations, to sell fake personal protective equipment via FaceMaskCenter.com,” said the Justice Department announcement. The statistics are staggering: According to the Federal Trade Commission, over 173,000 consumers have reported fraud cases related to the purchase of products or services related to COVID-19. The Department of Homeland Security reports $7.9 million seized in illicit proceeds and close to 1,000 seizures associated with prohibited COVID-19 test kits, prohibited pharmaceuticals, and counterfeit masks.

Looking Ahead – Collaboration is Key The pandemic has already had far-reaching consequences on society, governments and businesses. When there is a market and a big profit, organized crime and terrorist networks will seize on profitable opportunities and that is exactly what has happened. Illicit trade activities have increased virtually across every industry. And, while COVID-19 has been a catalyst to drive new and increased illicit trade, it’s also brought more attention to the issue and furthered collaboration – a critical element in dismantling the networks that facilitate this trade. There are already good examples of collaboration between the public and private sectors. In May, Homeland Security Investigations partnered with Pfizer, 3M, Citi, Merck and others to protect consumers from COVID-19-related fraud. In July, a coalition of 11 private- sector partners launched a public service awareness campaign to spotlight resources

www.cbrne-terrorism-newsletter.com 16 HZS C2BRNE DIARY – October 2020 available to help consumers combat the trade in fraudulent goods. Indeed, more needs to be done, but the partnerships and infrastructure to combat illicit trade are growing. Private and public partnerships are essential to combat illicit trade and to bring all relevant stakeholders together to address key issues. It is more important than ever for NGOs, law enforcement agencies, governments, academia, media and other sectors of civil society to continue coming together and exchanging expertise, ideas and opinions around our common goal: winning the fight against illicit trade and related crimes.

Hernan Albamonte is head of Illicit Trade Prevention U.S., Philip Morris International, Inc. Albamonte has been with Philip Morris International, Inc. for 13 years. He started with the company in his native country of Argentina, worked in Mexico, Central America and Switzerland before coming to Washington D.C. to head PMI’s illicit trade prevention efforts domestically.

The difference! Armenian three generations fighters.

They did not leave their country. They did not ask for asylum anywhere. They did not choose to live parasitically in another country and be NGO-funded. They fight for their homeland and the rights of their people. Respect!

Eco-Fascist ‘Pine Tree Party’ Growing as a Violent Extremism Threat By Ardian Shajkovci, Allison McDowell-Smith, Ph.D. and Mohamed Ahmed Source: https://www.hstoday.us/subject-matter-areas/counterterrorism/eco- fascist-pine-tree-party-growing-as-a-violent-extremism-threat/

Sep 27 – The authors’ research on Telegram – a messaging app known to be a hub for violent extremist propaganda and recruiting – revealed evidence that an eco-fascist movement, known as the “Pine Tree Party,” is rapidly expanding and accelerating their rhetoric online.

 Read the full article at source’s URL.

Ardian Shajkovci, Ph.D., is a counter-terrorism researcher, lecturer and security analyst, with field research experience in the Middle East (Iraq, Syria, and Jordan), Western Europe, the Balkans, Kenya, and Central Asia. He is co-founder and director of recently initiated American Counterterrorism Targeting and Resilience Institute (ACTRI), a U.S.-based research center predominantly focused on the domestic aspects of terrorism-related threats. Past positions include Research Director and Senior Research Fellow at the International Center for the Study of Violent Extremism (ICSVE) and positions and consultancies with domestic and international organizations. Allison McDowell-Smith, Ph.D. is co-founder and Deputy Director of American Counterterrorism Targeting and Resilience Institute (ACTRI). Allison is the Director of the Graduate Counterterrorism Program, Chair of the Undergraduate Criminal Justice Program, and Assistant Professor of Criminal Justice at Nichols College. She has launched

www.cbrne-terrorism-newsletter.com 17 HZS C2BRNE DIARY – October 2020 the Nichols Master of Science in Counterterrorism (MSC) Program, the first graduate program in the United States with a focus on Violent Extremism (VE) and leadership for those pursuing careers in the fields of security, intelligence, and public policy. Mohamed Ahmed is the Associate Chief Diversity Officer at San Diego State University and an Adjunct Professor of Preventing and Countering Violent Extremism in the San Diego State Universities Homeland Security Graduate Program. Mohamed is Director of Strategic Initiatives & Community Programming at American Counterterrorism Targeting and Resilience Institute (ACTRI).

Turkey’s Military Presence in Somalia and Tactical and Operational Implications for Al-Shabaab By Ardian Shajkovci, Allison McDowell-Smith, Ph.D., Mohamed Ahmed and Abdirizak Ismail Source: https://www.hstoday.us/subject-matter-areas/counterterrorism/soft-power-counterterrorism-turkeys-military-presence-in- somalia-and-tactical-and-operational-implications-for-al-shabaab/

March 2020 – The Turkey-Somalia partnership grew amid Somalia’s devastating humanitarian crisis in 2011. The then formed Turkey-Somalia partnership forged under the banner of humanitarian initiative eventually morphed into a nation-building project, which involved supporting Somalia in building roads, hospitals, educational institutions, and providing other forms of economic support. While Turkey remains on an economic development and nation-building trajectory in Somalia, it has also heavily invested in strengthening Somali military capacities to confront the threat of terrorism in the country. To demonstrate, through trainings held both in Turkey and Somalia, Turkey has to date trained close to 1,500 Somali soldiers out of its 10,000 commitment, working in tandem with the central Somali government to reduce Somali military dependence on the African Union (AU) troops and sustain combat efficiency in the long run. In addition, Turkey is building and training the nation’s air force, deemed a crucial military component in the fight against al Shabaab and other terrorist organizations. Manifested primarily in the form of military training offered to Somali troops, Turkey’s military presence in Somalia has by some accounts led to operational and strategic shifts on the part of al Shabaab. Such shifts were in part implemented to overcome power asymmetries and better confront government and government-protected targets since Turkey’s increased military profile in the country. Prior to Turkey’s involvement, al-Shabaab attacks were mostly directed at the African Union Mission in Somalia (AMISOM), the U.S. military, and other international forces in Somalia. Given Turkey’s focus on training and equipping Somali military force since opening its large military training facility in Mogadishu, Somalia, the group has shifted its operations and tactics to focus on large- scale attacks not only against civilians but also against Turkish aid workers, doctors, engineers, and facilities.

 Read the full article at source’s URL.

Abdirizak Ismail is a Senior Member at Samadoon Institute for Peace & Strategic Studies (SIPSS), Mogadishu, Somalia. Abdirizak also serves as a Senior Advisor & Program Coordinator for the Somali National Women Organization.

In Europe, Local Leaders Increasingly Frustrated with Pandemic Restrictions By Jamie Dettmer Source: http://www.homelandsecuritynewswire.com/dr20201005-in-europe-local-leaders-increasingly-frustrated-with-pandemic-restrictions

Oct 05 – In Madrid, the mayor has bowed before the law of the land, but has vowed to take Spain’s central government to the courts to try to reverse new more restrictive coronavirus lockdown rules. In Marseilles, the mayor has expressed her fury with Emmanuel Macron’s government for ordering the closure of all restaurants and bars in France’s second largest city, saying nothing justifies the order. In a string of northern English towns the anger is echoed. There, mayors are also questioning the orthodoxy of lockdowns, arguing that infection rates are trending up even in locked-down towns. They are not going as far as to ignore government instructions, although last week, Andy Preston, mayor of Middlesbrough, a struggling post-industrial town in Yorkshire, came close, suggesting at one point he might defy the order. Preston has bemoaned the central government’s decision to ban households mixing in pubs, restaurants and public spaces in the town of 138,000, saying new strict rules will have a detrimental effect on jobs as well as on mental health. Preston is not alone. City and regional leaders in several European countries are becoming increasingly frustrated with the pandemic restrictions central governments are imposing from

www.cbrne-terrorism-newsletter.com 18 HZS C2BRNE DIARY – October 2020 on high. Local leaders say they are better placed to know when and how to tighten restrictions, or whether they are needed at all. They fear central governments are not getting the balance right between protecting lives and saving livelihoods and businesses.

Resurgence The emerging pattern of pushback coincides with an alarming rise in infection rates in Europe. National governments are warning that the surge in cases, if not contained could end up overwhelming hospitals. The surge in cases is now being seen, too, in Italy and Germany, countries that had appeared to be bucking the trend. They were thought to have been squelching a second wave of infections being seen in neighboring countries. But on Saturday, Italy reached its highest daily tally since 24 April with authorities reporting 2,844 new infections, up from 2,499 cases the day before. Italy is one of the few countries where regional and local authorities tend to be even keener on lockdowns than central government, often imposing restrictions ahead of direct orders from Rome. In Campania, the regional president Vincenzo De Luca Saturday ordered all residents to wear face masks when they are outside their homes. “There is no third way. Masks must be worn on the face, not on the elbow. If the alternative is between having people dying on the street or taking a pleasant stroll, there will be no doubt … everything will close.” Campania is one of Italy’s most densely populated and poorest regions and it is now registering the highest daily tally of new infections in the country. “We must return to the strict behavior of February, March and April, otherwise we get sick,” he warned.

Anger Building But in other countries municipal frustration is boiling amid mounting fears of permanent economic damage. In both Britain and France, local leaders complain they are not being consulted before the announcement of new restrictions and are given no opportunity to help shape the rules. “The Marseille town hall was not consulted,” complained Michèle Rubirola, the mayor, last week after the government imposed tighter restrictions on the city. The decision to shutter restaurants and bars and left her “astonished and angry,” she said. The city’s first deputy mayor, Benoît Payan, criticized the restrictions and said the government had ignored a plea for a 10-day reprieve to show that the city’s own measures were working. “Once again our territory is being sanctioned, punished, singled out,” he says. “Our city has been put in virtual confinement without anyone having been consulted. Marseille deserves better than being beaten down, or of serving as an example,” he added. Many small business owners in Marseille agree with their local leaders. One restaurant owner, Laurent Catz, told Le Figaro newspaper the decision was “catastrophic” for his business.” “We cannot ignore the health situation but it is almost a death sentence for the profession,” he said. “We are still recovering and we are being shut down again.” Another restaurateur, Frédéric Leclair, told the newspaper: “I have trouble understanding this decision, especially since I have a beautiful terrace where I can enforce social distancing. Lack of uniformity in determining the reasons for lockdowns is not helping Britain’s ruling Conservatives to calm mounting frustration. Some city mayors and opposition parties in Britain are questioning whether bias dictates which towns and areas get locked-down. Jonathan Ashworth, a senior Labor party politician, told the BBC: “Because there is no clear guidelines as to why an area goes into restrictions and how an area comes out of restrictions then there is a suspicion that there is political interference - I hope there isn’t. But until the government publishes clear guidelines, that suspicion will always linger.” The government is being accused by some of sparing wealthy Conservative voting areas from local coronavirus lockdowns. Critics point out that Labor-voting areas with comparatively lower infection rates have been facing tougher restrictions than their more affluent neighbors. Dominic Harrison, director of public health in the town of Blackburn, wrote to ministers last week warning that more economically challenged boroughs were “ being placed into more restrictive control measures at an earlier point in their … case rate trajectory.” Other critics complain that districts represented by Cabinet ministers tend to escape local lockdown orders, despite sometimes having higher case numbers than districts ordered to shutter. Government officials say the incidence rate is “only one of a set of considerations regarding when it is appropriate to impose and release restrictions.” A Health Ministry spokesperson said in a statement: “While we recognize how much of an imposition these measures are, they are based on the latest scientific evidence in order to suppress the virus and protect us all while doing everything possible to support the economy.” But critics of the regional and local lockdowns warn the economic consequences are now becoming too hard to bear and risk leaving a permanent scar. The issue of public health versus public welfare and wealth is likely only to become more heated, say analysts, as unemployment rises and a rising number of businesses close permanently.

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Pragmatism, Individualism Municipal and regional critics of central government-dictated lockdowns appear to be catching the public mood in some countries. “National solidarity and unthinking compliance is evolving into a more pragmatic, individualist mood,” according to commentator Janice Turner. “Every time the rules change, they lose a little more faith,” she says. The rules are becoming white noise and as they do so “more people will resort to what they think is right,” she adds. A “Zero Covid” strategy won’t work long-term, critics warn. Government officials across Europe counter they are only following the science. But this is now being questioned by some scientists themselves, who say the trade-offs are not something they should decide. “Both the virus and the ways of tackling it cause harm and need to be balanced: for example, how much should young people’s education be compromised to protect older people from infection? This is a ‘wicked problem’ with no winners in which we are trying to trade jobs, freedoms and health against each other,” says Graham Medley, professor of infectious disease modeling at the London School of Hygiene and Tropical Medicine. Writing in The Times newspaper he said: “While scientists can ensure that any strategies are underpinned by the best evidence and research, they should have no greater say in them than economists, ethicists, historians and the wider public. The question of whether New Zealand’s approach is ‘better’ than Sweden’s is as much a social as a scientific one,” he added. New Zealand and Sweden have pursued dramatically different pandemic strategies. Sweden has taken a much softer more hands- off approach, while New Zealand put in place lockdown measures earlier this year even before their first case was recorded. In Madrid, Isabel Díaz Ayuso, the president of greater Madrid’s regional government, has warned that more restrictions will be “the ruin of Madrid and the ruin of Spain.” The Spanish economy contracted by 18.5% in the second quarter of this year. What she has dubbed “arbitrary rules” will result in “queues of hungry people again and unemployment figures that will multiply tenfold.” On the streets of Middlesbrough last week, the town mayor’s frustration with the new more restrictive rules appeared to resonate with many locals saying they fear that combating the virus is elbowing out the equally important goal of saving livelihoods. Paula Hoare, 27, told reporters, “The mayor is sticking up for the town where there is already massive poverty.”

Jamie Dettmer is VOA reporter.

Is the United States Heading for a Rural Insurgency? Source: http://www.homelandsecuritynewswire.com/dr20201005-is-the-united-states-heading-for-a-rural-insurgency

Oct 05 – The intrusions of white supremacist militias into cities to intimidate, and at times attack, protestors from the Black Lives Matter (BLM) movement highlights the possibility of rural insurgency, Vasabjit Banerjee writes in Just Security. He notes that rural insurgencies range from week-long armed rebellions against local governments, law enforcement, and the wealthy to decades-long ones against subnational and national-level security forces, which seek to impose new revolutionary regimes. Many African, Asian, and Latin American countries have faced such insurgencies. Banerjee writes: In her book on white supremacist groups, Bring the War Home:The White Power Movement and Paramilitary America, Professor Kathleen Belew shows that the grievances of rural white militia groups center on threats to white racial supremacy that date back to the U.S. defeat in the Vietnam War. These have recently combined with fears of becoming a minority group due to changing demographics. The targets of such fears have shifted from primarily African Americans to include non-White immigrants. In conjunction with racial fears, other causes include anti-Semitism as well as perceived threats to Christianity from Muslims, who have replaced Catholics as antagonists. Some scholars have observed, however, that the militias do not constitute a cohesive movement, but have many groups with varied beliefs, broadly classifiable as anti-federal government control of lands, guns, speech, and other liberties. Banerjee writes that although culture, economic or political grievances underlie such rebellions, a successful rebellion must overcome barriers such as availability of weapons, rebel organizations and leadership, training, as well as funding from wealthy allies. Banerjee notes that Mao Zedong allegedly remarked that rebels should inhabit their environment as fish in the sea, which was the case in mid-20th Century China with its rural hinterland where the vast majority of the population resided. Twenty-first Century United States, however, has a mostly urban population. In a social media interaction with me, Professor Doug Thompson of the University of South Carolina mentioned that less than 2 percent of the American population lives in 100 percent rural countries, while most states have “roughly the same spatial

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distribution of partisanship,” which neither overlaps with traditional regions like the North, South, Midwest, etc. nor with urban/rural divides. Rather, what he terms the “new sectional conflict,” in a reference to antebellum regional divisions, could be centered in the exurban and suburban areas. In which case, the nearness to urban centers may mitigate conflict by facilitating pacification efforts, which may even deter insurgencies from breaking out, or worsen insurgencies because of the accessibility to high-value urban targets and populations. Despite how the political geography of the United States ultimately shapes the nature of such insurgencies, however, the above-mentioned grievances, resources, and opportunities indicate that the preconditions for insurgencies are already present. Consequently, militia groups deserve more scrutiny from security forces and a unified political consensus to deter and suppress them in order to maintain peace and stability.

Combating the Virus: Mass Unemployment is Not the Solution By Prof Michel Chossudovsky Source: https://www.globalresearch.ca/combating-the-virus-mass-unemployment-is-not-the-solution/5724926

Oct 05 – Millions of people around the World are victims of the fear campaign. Panic prevails. Day after day, the persistent impact of media disinformation concerning the Killer Virus is overwhelming. Fear and panic, coupled with outright lies prevent people from understanding the logic of these far-reaching economic and social policies. On March 11, 2020 the WHO declared a Worldwide pandemic, requiring the lockdown and closure of the national economies of 193 member states of the United Nations, with devastating economic and social consequences: unemployment, poverty, despair. These authoritarian measures imposed on millions of people were accepted outright. Public opinion was led to believe that the measures were a solution to combating the “Killer Virus”.

 Read the full article at source’s URL.

Michel Chossudovsky is an award-winning author, Professor of Economics (emeritus) at the University of Ottawa, Founder and Director of the Centre for Research on Globalization (CRG), Montreal, Editor of Global Research.

Updated: American Deaths in Terrorist Attacks 1995-2019

START has released updated statistics on the total number of terrorist attacks that took place in the United States, the total number of deaths due to terrorist attacks in the United States, the total number of U.S. deaths due to terrorist attacks in the United States, and the total number of U.S. deaths due to terrorist attacks worldwide, from 1995 to 2019.

US Deaths in the United States: 3,492

New report highlights 10 critical technologies for future security Source: http://www.worldsecurity-index.com/pressdetails.php?id=8934&type=1

Sep 29 – The development of emerging technologies must be accelerated to mitigate the growing threat of cyberattacks and asymmetric conflict, dubbed the grey zone, is the key finding of the new Confidence in Chaos report from global defence and security company, QinetiQ. Grey zone approaches explore the widest range of social, political, economic and security instruments available to achieve maximum effect. They do not, however, usually provoke a conventional response and are sometimes not recognised as formal acts of aggression. The use of technology makes it easier for adversaries to attack, interfering in critical national infrastructure, government or commercial institutions.

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Released locally today through Abu Dhabi based Houbara Defence & Security LLC, QinetiQ’s UAE joint-venture partner, the report looks at shifts from traditional threats to grey zone or sub-threshold tactics employed by a wide range of adversaries, highlighting the critical role that technology plays in both enabling grey zone attacks and protecting against them. It provides 10 technology examples that QinetiQ sees as being crucial to counter grey zone tactics. The first is AI, analytics and advanced computing, which are seen as the core of the solution. The second and much less recognised area of vulnerability is the electromagnetic spectrum where critical infrastructure can be targeted through communication signals, Wifi and GPS being jammed or misdirected. Fast developing novel technologies is the third area of focus. The report describes how directed energy, such as lasers, are well suited to counter threats posed by drones and other unmanned devices. Technologies that mitigate the risk to the disruption of conventional power supplies by identifying scenarios that require highly specialised energy storage and delivery systems is the fourth area of opportunity. Fifth, greater use of robotics and autonomous systems are required to provide more granular situational awareness, as well as helping to expand a user’s sphere of influence. This is closely linked to the sixth priority, where communication lies at the heart of countering grey zone operations. Advances in sensor technology is the seventh focus, enhancing situational awareness by creating new techniques to gather data, by identifying adversaries’ locations and intentions of both their physical and digital domains. The rapidly shifting nature of potential threats means that new materials and manufacturing capabilities must be fast-tracked into service, this is the eighth opportunity that the report explores in detail. The ninth focuses on how new capabilities can be safely introduced. All new technologies and procedures should be developed with human factors in mind, so exhaustive testing and live exercises are essential to expose hidden risks. Finally, the report cites the need for greater adaptability of platform and system design. With increasing emphasis on budget efficiency and the need to adapt existing capabilities to tackle changing threats, consequently new systems must be designed to serve multiple evolving roles. Mike Sewart, Group CTO, QinetiQ said “Grey zone tactics are today’s reality and organisations have no option but to adapt. Emerging and existing technologies hold the key to achieving competitive advantage when countering grey zone attacks. Simply doing what we’ve always done is neither recommended nor possible. Instead, we must embrace a more scientific and technology-focused approach.” With commercial technologies being turned into available products faster than ever before, it is easier for adversaries to find new ways of challenging. Access to new communications technologies in particular are enabling adversaries to achieve critical mass, equip and mobilise very quickly. Sewart concludes: “With budgets around the world coming under increasing public and government scrutiny, we are at cross-roads in how we evolve our security infrastructure to be fit for purpose. Traditional strategies tend not to deal with grey zone tactics, so a new approach needs to be readily considered and deployed”.

Terrorism: Its Past, Present & Future Study - A Special Issue to Commemorate CSTPV at 25 By Gillian Brunton and Tim Wilson Contemporary Voices: St Andrews Journal of International Relations, 1(1), pp.1–88. Source: https://cvir.st-andrews.ac.uk/articles/1601/

Abstract The Centre for the Study of Terrorism and Political Violence at the University of St Andrews (CSTPV) was founded in August 1994 and with it an enduring scholarly tradition that continues to evolve. Indeed, it was to celebrate the 25th anniversary of the CSTPV’s foundation that leading academics gathered in St Andrews on 7-8th November 2019 to debate the past, present and future study of terrorism. This special edition of CVIR seeks to capture the general effervescence of that symposium. Its format has been deliberately cast as an academic conversation in print. Short versions of original papers given at the symposium are reproduced: but each paper is, in turn, commented upon by another esteemed contributor. Thus, the whole special issue tries to retain a little of the quality of lively debate and interchange of opinion that marked the original gathering.

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Beyond 9/11: U.S. Security Needs in the 21st Century Source: http://www.homelandsecuritynewswire.com/dr20201008-beyond-9-11-u-s-security-needs-in-the-21st-century

Oct 08 – The year 2020 has featured an array of safety and security concerns for ordinary Americans, including disease and natural disasters. How can the U.S. government best protect its citizens? That is the focus of a new scholarly book with practical aims, Beyond 9/11: Homeland Security for the Twenty-First Century, published by the MIT Press. The volume features chapters written by 19 security experts, and closely examines the role of the Department of Homeland Security (DHS), which was created after the September 2001 terrorist attacks on the U.S.

Erdoğan and His Arab "Brothers" By Burak Bekdil Source: https://www.meforum.org/61634/erdogan-and-his-arab-brothers

Oct 08 – Neither the Ottoman nor the modern Turkish language has ever been short of racist proverbs denigrating Arabs and their culture. No more, said Recep Tayyip Erdoğan, the Islamist leader who has been at the helm in Turkey since 2002. He made it a habit to publicly refer to Arabs, including his then regional nemesis Syrian president Bashar Assad, as "my Arab brothers." His goal was to build a Muslim-Arab pact, a modern umma under Turkish leadership as in Ottoman times, to challenge Israel in the region and, more broadly, Western civilization. In 2010, Turkey's state broadcaster TRT even launched an Arabic language channel, TRT Arabi. Sadly, for Erdoğan, his attempt to fuse Islam and anti-Zionism seems to have fallen apart. Turkish diplomats officially said the recent normalization deal between the UAE and Israel meant Abu Dhabi was betraying the "Palestinian cause." This response from Ankara looked ridiculous, as it appeared to have forgotten that Turkey itself has had diplomatic relations with Israel since 1949. Turkish Islamists apparently do not care about looking ridiculous. In its September 10 edition, Yeni Akit, a staunchly pro-Erdoğan and Islamist militant newspaper, said the "Saudis were competing with the UAE in treason [against the 'Palestinian cause']." Yeni Akit was referring to the decision by Saudi Arabia and Bahrain, in a landmark change of policy, to allow all flights to and from Israel to use their airspace. The

www.cbrne-terrorism-newsletter.com 23 HZS C2BRNE DIARY – October 2020 trouble with that criticism is that there too, Israel is one of the 138 countries with which Turkey has mutual accords for the use of airspace. According to this logic, diplomatic relations with Israel and flights using the airspace of both countries are privileges that should be accorded to one Muslim country alone: Turkey. If other Muslim countries sign identical accords with Israel, it's treason. This rhetoric reflects Turkey's increasing loneliness in the Muslim/Arab world (with the sole exception of Qatar) after several years of loneliness within the NATO alliance. Turkey can thus claim the bizarre title: "Odd man out in both NATO and the Muslim world." This state of affairs has been coming on for years, but Erdoğan has stubbornly refused to recalibrate his policy. In early 2019, six nations, including the Palestinian Authority (Erdoğan's ideological next of kin), agreed to found the Eastern Mediterranean Gas Forum. At a July 2019 meeting in Cairo, the energy ministers of Egypt, Cyprus, Greece, Israel, Italy, and the PA, as well as a representative of the energy minister of Jordan, said they would form a committee to elevate the Forum to the level of an international organization that respects the rights of its members to their natural resources. Erdoğan privately felt betrayed by this act of treason from his "Palestinian brothers," comforting himself that the traitors were not members of his beloved Hamas. In October 2019, the Arab League condemned Turkey's cross-border military operation in northeast Syria as an "invasion of an Arab state's land and an aggression on its sovereignty." The League would consider taking measures against Turkey in the economic, investment, and cultural sectors, including tourism and military cooperation. It also called on the UN Security Council to "take the necessary measures to stop the Turkish aggression and [enforce] the withdrawal from Syrian territory immediately." To Ankara's deep embarrassment, its closest regional ally, Qatar, did not block the League's communique condemning Turkey. Turkey's reaction was characteristically childish. Fahrettin Altun, Erdoğan's communications director, said the Arab League does "not speak for the Arab world." An angry Erdoğan said, "All of you [Arab nations] won't make one Turkey." That's quite a drift from his "our Arab brothers" rhetoric. Apparently in the Turkish world of make-believe, only Turkey's Islamists or those with a seal of approval from Ankara can speak for the Arab world. Worse, Erdoğan et al believe this idea can sell on the Arab street if it is dressed up in nice anti-Zionist, pro-Hamas rhetoric. On September 9, the Arab League condemned Turkey (along with Iran) for "interference in the region and the Palestinian cause." At the League's foreign ministers' meeting, Egypt's FM Sameh Shoukry said Cairo "will not stand motionless in face of the Turkish greed that is especially being shown in northern Iraq, Libya, and Syria." Once again, Ankara "totally rejected" all the decisions taken at the meeting. Murat Yetkin, a prominent Turkish journalist and editor of Yetkin Report, recently wrote: "With the exception of [currently ambiguous] Libya and Qatar, what unites the Arabs now is no longer anti-Israeli sentiment but anti-Turkish sentiment." That's quite a long political journey to travel, and a tough destination for Erdoğan.

Burak Bekdil is an Ankara-based political analyst and a fellow at the Middle East Forum.

EDITOR’S COMMENT: This is a very accurate description of the overall situation in this part of the world. A single person has an ugly dream and in order to fulfit it he should upset the entire planet. By the way: the Turkish-Qatari relationship is strange. Turkey is big and poor; Qatar is small and rich. Qatar donates to Turkey to be protected from Saudi Arabia. In the real world, if S. Arabia would like one day to take over Qatar, do Qataris believe that Turkey will attack Saudis? Besides, the war will be over before Erdoğan decides what is best for him.

COVID-19 and the Increasing Risk of Terrorism By Mohamed ELDoh Source: https://globalsecurityreview.com/covid-19-and-the-increasing-risk-of-terrorism/

Oct 02 – There is no doubt that the global COVID-19 pandemic has disrupted nearly every aspect of life. From how we interact with one another to how we commute and work, people now are facing new realities that were not present just six months ago. Though the main concerns for many policymakers, government officials, and business leaders include managing the ongoing global health crisis and its economic ripple effects, other unanticipated risks may already be shaping up. These include a growing threat of extremism and terrorism. The terms of extremism and terrorism have been used interchangeably. However, there is a crucial distinction between the terms: all terrorists are extremists, but not all extremists are terrorists. Despite the latter, a fine line separates extremists from the turning point of

www.cbrne-terrorism-newsletter.com 24 HZS C2BRNE DIARY – October 2020 embracing violence—thus becoming terrorists. This is because extremism is generally regarded as “the vocal or active opposition to our fundamental values, including democracy, the rule of law, individual liberty, and respect and tolerance for different faiths and beliefs” as per the 2015 UK’s Counter-Extremism Strategy. Furthermore, extremists may resort to terrorism to coerce governments and the general public to give in to their cause. Over the past couple of decades, extremism and terrorism were mostly associated with religious causes, especially Islamic extremism, which present a persistent threat to numerous states. Yet, the current pandemic crisis may fuel such a risk and threats from other extremism categories. This includes the right-wing, left-wing, and single-issue extremism. While clearly articulating from now why and how the case is cumbersome, government and national security leaders can relate early warning signs to counter these threats. Some arguments are claiming that terrorist groups are currently preoccupied with protecting their members against the coronavirus. However, different incidents that took place over April 2020 points to the direct opposite. In fact, in its mid-March al-Naba newsletter, ISIS urged its followers to launch attacks in times of crisis and show no mercy. Earlier in April, 25 soldiers in Mali were killed in a jihadist attack. On the 14th of April, in an operation where one police officer killed, Egyptian security forces exchanged fire. They eliminated seven terrorists who were part of a cell planning to conduct attacks during the Easter holiday in Egypt. Also during mid-April, the Tunisian security authorities foiled a terrorist plan to spread the coronavirus to Tunisian security forces by coughing, sneezing, and spitting. On the 21st of April 2020, it was announced that one of Europe’s most wanted terrorists and ISIS affiliate, Abdel Majed Abdel Bary, was recently arrested by the Spanish police in Almeria where he settled in during the coronavirus lockdown. Abdel Bary reached Spain via a boat, and local newspapers indicated that he intended to return to the UK. The return intentions of Abdel Bary – who was arrested with another two persons in his apartment – remains unclear. In France, on the 27th of April, a 29-year-old Frenchman was also arrested. The man, who was not identified, has slammed his car into police cars and motorcycles, injuring three officers. It was found that the man has pledged allegiance to ISIS in a letter found in his car. A couple of days later, in a statement by the Danish authorities on the 30th of April, the police in Denmark prevented a terrorist attack with a possible “militant Islamic motive.” The arrested man was already suspected of attempting to obtain ammunition and firearms. On the 30th of April, in one of the deadliest attacks that month, ten Egyptian army personnel were killed in a terrorist attack. The incident, which included an officer, a non-commissioned officer, and eight soldiers, had an improvised explosive device (IED) detonated under their armored vehicle in Bir El-Abd in North of Sinai. Looking at Iraq, we can see a rise in ISIL (ISIS) operations over the past few months, wherein the first three months of 2020, 566 attacks were conducted by the group in Iraq. Not only that, the group’s attacks have intensified, but the group appears to be strengthening. Given their recent attacks in Syria and Iraq, it is argued that the current pandemic has already demonstrated how durable and resilient ISIS ais In addition to that, other armed extremist groups are scaling up their targeted attacks. This can be evident by the recent assassination of Hisham al Hashimi, 47, who was fatally shot outside his house in Baghdad. Hisham was among the world’s leading security experts on ISIS and other armed groups. Iraqi officials indicated that Hisham received threats recently from Iran backed militias. Because of the abovementioned incidents – even if they may appear minor and sporadic to some security strategists – it is worth noting that terrorist groups may take advantage of the global focus of countering the pandemic and launch attacks. Furthermore, terrorist groups may view the global pandemic crisis as an opportunity to win more recruits, supporters, sympathizers, and then strike harder than before should the right moment be presented. In this regards, Al-Qaeda suggested in its statement on the 30th of March, that non-Muslims use their time in quarantine to learn about Islam. In addition, these groups have never failed to exploit social media to advance their cause and propaganda. That said, as the pandemic continues, people are spending more time online, terrorist groups are likely to amplify their utilization of

www.cbrne-terrorism-newsletter.com 25 HZS C2BRNE DIARY – October 2020 social media to further spread their dangerous rhetoric along with widely used hashtags of the terms: #Coronavirus, #COVID2019 or #COVID19 to ensure a wider audience reach for their social media posts. Not only that, terrorist groups may use the time of the pandemic crisis to propagate their ideology or launch attacks but also use the time to reinforce their bases to remerge in a more potent form after the pandemic crisis. This can be specifically true given that most terrorist groups are taking some of the African and Middle Eastern countries like Libya, Chad, Mali, Nigeria, Somalia, Syria, Iraq, Afghanistan, and others as their hubs and operational base. Most of these nations are developing countries, so it is possible that while these nations’ authorities and security forces are focusing their capabilities on curbing the coronavirus spread, that terrorist groups would utilize such a window period to harness their abilities. This is particularly evident from the very recent series of terrorist attacks launched by ISIS in Syria and Iraq, killing dozens of soldiers. The attacks probably took advantage of the local authorities scaling back the number of troops on the ground due to the coronavirus pandemic. A similar expansionary approach is also seen by jihadists in the Sahel region. Thus, further confirming the threat resurgence of organized terrorist groups as a result of the pandemic crisis. Although the terrorism threat appears to be relatively regional, it requires intergovernmental and a multinational collective counterterrorism approach. With many of the terrorist groups and affiliates adopting a horizontal structure, one group in one country might be influencing the actions of other groups in many other different countries. Not to forget lone wolf terrorism, which would only take the individual perpetrator to be radicalized by merely reading and following the propaganda and extremist ideologies widely available online. While intergovernmental counterterrorism frameworks, cooperation, and efforts already exist, the current pandemic crisis still presents an unprecedented challenge to many countries. This includes the redirection of security forces and militaries’ actions in curbing the pandemic spread, implementing lockdowns, curfews, regulating borders entry, and supporting the national overwhelmed healthcare authorities. Though the latter is important to ensure the general public safety, security bodies mustn’t lose their focus on countering terrorism, reinforcing border security, and stepping up surveillance and intelligence activities to anticipate any risks or terrorism plots. Additionally, extremist – but nonviolent – groups should be closely monitored during the pandemic and economic crisis to counter how such groups might use the pandemic to advance their propaganda and gain more sympathy from the general public. This includes right-wing, left-wing, and single-issue extremism groups such as climate activists who turn to terrorism. Furthermore, as the economic recession builds up, different countries may implement spending cuts and reduce budgets dedicated to national security, intelligence, military, and law enforcement concerning various security programs, including counterterrorism. Accordingly, this should not be the case at all. Even if the economic recession is currently taking its toll on all sectors, government spending, and budgets dedicated to national security, intelligence, military, and law enforcement, counterterrorism efforts should not be reduced. As extremists and terrorist groups are likely to exploit the coronavirus pandemic and post-pandemic economic crisis for their benefit and incite violence, national governments should not undermine such a dormant yet imminent threat while tackling the economic consequences of the pandemic crisis. In this respect, military, national security, intelligence, and law enforcement bodies across the world should increase, and hone their counterterrorism capabilities, intelligence sharing, and international cooperation.

Mohamed ELDoh is a business development and consulting professional in the security and defense sector. Mohamed holds an MBA from the EU Business School, an Advanced Certificate in Terrorism Studies from the University of St Andrews, and is a doctoral candidate at the Grenoble École de Management, where he researches strategy and online behavior.

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Greece: Leaders of Neo-Nazi Group Golden Dawn Convicted of Murder Source: http://www.homelandsecuritynewswire.com/dr20201009-greece-leaders-of-neonazi-group-golden-dawn-convicted-of-murder

Oct 09 – After a five-year-long trial, the Greek court on Wednesday found members of the neo-Nazi party Golden Dawn guilty of murder and assault. The neo-Nazi group’s leader was convicted of running a criminal organization. Thousands of police officers were stationed around the Athens courthouse as the verdict was read and tear gas and water cannons were used to disperse crowds. Over 10,000 protesters gathered to take part in antifascist rallies outside. The presiding judge, Maria Lepeniotou, announced the verdict following the extended legal procedures and 453 court sessions. The 68 members of the extreme right-wing party, including 18 former lawmakers, faced charges the murder of Greek antifascist rapper Pavlos Fyssas, assaulting a migrant fisherman, attacks on left-wing activists and constituting a criminal organization. “Pavlos succeeded,” the rapper’s mother, Magda Fyssa, announced, to roaring applause from the crowd, according to the Kathimerini newspaper. The defendants included Golden Dawn founder Nikos Michaloliakos and members of his inner circle. They now face 10 years in prison.

Eagerly Anticipated Verdict The prosecution caused an uproar in 2019 when chief prosecutor Adamantia Economou suggested acquitting party leaders due to lack of evidence. The neo-Nazi party was founded in the 1980s and rose to prominence during Greece’s decades-long financial crisis, entering parliament in 2012 as the third-largest group with 12% of the vote. The prosecution began in connection with the murder of the Pavlos Fyssas in 2013. The rapper was stabbed to death in Athens after being chased by a gang of Golden Dawn thugs. Preliminary investigations found that the party operated as a paramilitary organization with orders passed from the central leadership to local groups to carry out attacks against migrants, often leading to serious injury.

Death Knell of Fascism The question at the center of the trial was whether the spate of violent assaults, many of which occurred during 2013, could be linked to the party’s leadership. The defense had claimed that there was insufficient evidence to prove this connection. The party had hoped for the charges to be dropped, calling them an “unprecedented conspiracy” and for a resurgence in nationalist populism that would bring them back into parliament after having failed to reach the 3% threshold in the previous election. On Tuesday, before the verdict was announced, political parties across the board condemned Golden Dawn, with a spokesman from the governing New Democracy party, Stelios Petsas, telling Kathimerini, “New Democracy is and was a perennial adversary to every [force] that undermines the state and [political] normalcy.” The leader of the leftist party Syriza, and former prime minister, Alexis Tsipras, called for rallies, accusing Golden Dawn of “sowing hate, beating, murdering,” in a statement to Kathimerini.

DHS Calls Racially Motivated Extremism the ‘Most Persistent and Lethal’ Domestic Violent Extremist Threat By Bridget Johnson Source: https://www.hstoday.us/subject-matter-areas/infrastructure-security/dhs-calls-racially-motivated-extremism-the-most- persistent-and-lethal-domestic-violent-extremist-threat/

The Department of Homeland Security’s new Homeland Threat Assessment released this week sparked a rebuke from the acting secretary over the House Homeland Security Committee chairman’s reading of white supremacy as the greatest domestic threat the country currently faces.

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The 26-page report was released two days before it was revealed that the FBI intercepted an elaborate plot by militia extremists to kidnap the governor of Michigan from her vacation home or stage an armed, hostage-taking raid on the state capitol. The suspects were allegedly upset over the governor’s regulations to control the COVID-19 pandemic, and also expressed the accelerationist intent to spark a civil war. “We also remain particularly concerned about the impacts from COVID-19 where anti-government and anti-authority violent extremists could be motivated to conduct attacks in response to perceived infringement of liberties and government overreach as all levels of government seek to limit the spread of the coronavirus that has caused a worldwide pandemic,” the threat assessment says on page 19. “Ideologies driven by such [domestic violent extremists] often are reinforced by a variety of online content, including conspiracy theories and political commentary they view as controversial. Current events that DVEs perceive as infringing on their worldviews often contribute to periods of increased ideologically motivated violence, including recently during the COVID-19 pandemic and nationwide lawful protests.” The assessment is structured by the categories of cyber threats, naming Russia and China as the foreign actors posing the greatest risk; foreign influence activity, including disinformation campaigns targeting the election and COVID-19; threats to economic security, including destabilization from the pandemic and intellectual property theft; terrorist threats, including international groups, domestic movements, and lone actors; transnational criminal organizations, including drug cartels and human smuggling; illegal immigration as “flows within the Western Hemisphere have begun to increase after a short-term decline in response to the world-wide COVID-19 pandemic and countries instituting border transit restrictions”; and natural disasters that “require the Department to readjust its priority focus, as resources continue to be reallocated to focus on responding to multiple natural disasters, while continuing to handle its traditional roles and responsibilities.” “The primary terrorist threat inside the United States will stem from lone offenders and small cells of individuals, including Domestic Violent Extremists (DVEs) and foreign terrorist-inspired Homegrown Violent Extremists (HVEs),” the assessment states. “Some U.S.- based violent extremists have capitalized on increased social and political tensions in 2020, which will drive an elevated threat environment at least through early 2021. Violent extremists will continue to target individuals or institutions that represent symbols of their grievances, as well as grievances based on political affiliation or perceived policy positions.” COVID-19 has introduced or exacerbated stressors — such as mental health issues brought on or worsened by social isolation, or job losses that can precede radicalization — that could also drive extremists to violence, the report notes. Also, the presidential election — “the election itself, election results, or the post-election period” — could spur violent actors to “mobilize quickly to threaten or engage in violence.” “Some DVEs have heightened their attention to election- or campaign-related activities, candidates’ public statements, and policy issues connected to specific candidates, judging from domestic terrorism plots since 2018 targeting individuals based on their actual or perceived political affiliations,” the assessment states. “Open-air, publicly accessible parts of physical election infrastructure, such as campaign-associated mass gatherings, polling places, and voter registration events, would be the most likely flashpoints for potential violence.” The report states that “among DVEs, racially and ethnically motivated violent extremists—specifically white supremacist extremists (WSEs)—will remain the most persistent and lethal threat in the Homeland.” “Spikes in other DVE threats probably will depend on political or social issues that often mobilize other ideological actors to violence, such as immigration, environmental, and police-related policy issues,” the assessment adds. White supremacists “have demonstrated longstanding intent to target racial and religious minorities, members of the LGBTQ+ community, politicians, and those they believe promote multi-culturalism and globalization at the expense of the WSE identity. Since 2018, they have conducted more lethal attacks in the United States than any other DVE movement,” the report continues. “Some WSEs have engaged in outreach and networking opportunities abroad with like-minded individuals to expand their violent extremist networks. Such outreach might lead to a greater risk of mobilization to violence, including traveling to conflict zones.” House Homeland Security Committee Chairman Bennie Thompson (D-Miss.) told The New York Times that “this threat assessment confirms two things: that white supremacist extremists are the top domestic threat to the homeland, and they are often inspired by President Trump’s rhetoric.” Acting DHS Secretary Chad Wolf retorted in a statement the next day that Thompson “misrepresented the facts” in the assessment, saying the report “does not specifically identify a ‘top domestic threat to the Homeland.’” “Instead, we address each unique threat stream with the most lethal and dangerous groups operating within those threat steams – from Domestic Violent Extremists to transnational criminal organizations,” said Wolf, who was nominated by Trump last month to the

www.cbrne-terrorism-newsletter.com 28 HZS C2BRNE DIARY – October 2020 permanent role leading DHS. “More importantly, the HTA does not state, in any way, that any groups are inspired by the President’s statements. That is a fabrication.” In addition to a domestic threat environment that “is rapidly evolving,” the assessment says the threat from foreign terrorist organizations including ISIS and al-Qaeda continues “but we expect the primary threat from these groups to remain overseas in the coming year” as they call for lone actors within the United States to commit attacks on behalf of the terror groups. “Transportation infrastructure—especially the aviation sector—almost certainly will remain a primary target for terrorists plotting overseas. While terrorists continue to pursue flight school training and the use of insiders, plotting against domestic aviation targets most likely will remain aspirational among FTOs and their supporters over the next year,” the assessment states. “Terrorists and other criminal actors might look to unmanned aircraft systems (UAS) to threaten critical infrastructure. In 2019, there were nearly 4,000 reports of unique incidents of UAS activity near U.S. critical infrastructure or public gatherings. Although we have no indication that any of these events were terrorism-related, it is possible that malicious or criminal actors will turn to UAS tactics.”

Bridget Johnson is the Managing Editor for Homeland Security Today. A veteran journalist whose news articles and analyses have run in dozens of news outlets across the globe, Bridget first came to Washington to be online editor and a foreign policy writer at The Hill.

A small break in pandemic depression

North Korea unveils massive new ballistic missile in military parade Source: https://edition.cnn.com/2020/10/10/asia/north-korea-military-parade-new-missiles-intl-hnk/index.html

Oct 10 – North Korea unveiled what analysts believe to be one of the world's largest ballistic missiles at a military parade celebrating the 75th anniversary of the Workers' Party broadcast on state-run television on Saturday. The massive weapon was carried by an 11-axle truck at the climax of the almost two-hour ceremony and military parade in the capital of Pyongyang.

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Analysts said the new missile is not known to have been tested, but a bigger weapon would allow North Korea to put multiple warheads on it, increasing the threat it would pose to any targeted foe.

North Korea unveiled what analysts believe to be the world's largest liquid-fueled intercontinental ballistic missile at a parade in Pyongyang early Saturday.

US Army working on AR glasses for military dogs Source: https://newatlas.com/vr/dog-augmented-reality-glasses-us-army-military-ar-vr/

Oct 11 – The United States Army is developing augmented reality goggles for military dogs. The technology is being designed to enhance communication between the dog and its human handler, allowing for more remote commanding of the animal. Communication between military working dogs and their handlers generally requires the handler to be in close proximity to the animal. Verbal commands, hand signals, and even laser pointers are often used to direct the canines. However, in some military contexts it can be unsafe for a handler to be close to the animal, so there is a need for some of technology that enables commands to be delivered without a human being close by. In the past, cameras and walkie talkies have been used to remotely communicate with military dogs but these methods can frequently lead to confusion in the animals. The new system being developed uses augmented reality to provide a visual cue for the dogs while a camera in the goggles offers a live feed of the canine’s point-of-view for the handler to monitor. “Augmented reality works differently for dogs than for humans,” explains Stephen Lee, a senior scientist in the Army Research Office. “AR will be used to provide dogs with commands and cues; it’s not for the dog to interact with it like a human does. This new technology offers us a critical tool to better communicate with military working dogs.” The system, currently in its prototype stages, uses a type of protective glasses that military dogs are already trained to wear. Each device is customized, with the dog being 3D scanned so the system can be specifically constructed for the animal. “Even without the augmented reality, this technology provides one of the best camera systems for military working dogs,” Lee suggests. “Now, cameras are generally placed on a

www.cbrne-terrorism-newsletter.com 30 HZS C2BRNE DIARY – October 2020 dog’s back, but by putting the camera in the goggles, the handler can see exactly what the dogs sees and it eliminates the bounce

that comes from placing the camera on the dog’s back.” The project is managed by the Army Research Office but the technology has been specifically developed by a company called Command Sight. Founded in 2017 by A.J Peper, Command Sight is a start-up investigating technological solutions to improve communication between humans and animals. “We are still in the beginning research stages of applying this technology to dogs, but the results from our initial research are extremely promising,” says Peper. The preliminary prototype has proven effective and the project is now in its second phase. The system is currently not wireless, so the next two years will focus on producing a wireless, production-ready device. “Much of the research to date has been conducted with my Rottweiler, Mater,” says Peper. “His ability to generalize from other training to working through the AR goggles has been incredible. We still have a way to go from a basic science and development perspective before it will be ready for the wear and tear our military dogs will place on the units.”

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Wearable sensors can be printed directly onto skin at room temperature Source: https://newatlas.com/wearables/wearable-sensors-printed-skin-room-temperature/

Oct 12 – Flexible electronics have opened up some interesting possibilities when it comes to wearable sensors that can be applied to the skin, taking the form of tattoo-like films and sleeves that monitor various aspects of human health. Scientists at Penn State University have now developed one they say can be safely printed directly onto the skin, where it can track things like body temperature and blood oxygen levels, before being washed off once the job is done. The new printable sensors build on earlier work by the same researchers, in which they developed flexible circuit boards for use in wearable sensors. But a key part of this process involved bonding some of the metallic components together at the kinds of temperatures not well tolerated by the human body, at around 572 °F (300 °C). This scorching hot sintering process is what had prevented the team from printing their flexible circuit boards directly onto human skin, but it may have now found a way around this problem. The key is what the scientists call a sintering aid layer, which acts as a kind of buffer and enables the materials to bond together at far safer temperatures. The winning formula for this layer consists of a polyvinyl alcohol paste combined with calcium carbonate, materials found in peelable face masks and egg shells, respectively. This layer serves to smooth out the surface of the skin and allow a very thin layer of metal patterns to be printed directly on top at room temperature, which is then set with an air-blowing device. This flexible circuit maintains its electrochemical properties and can be tuned to continuously record data on temperature, humidity, blood oxygen and heart signals, according to the team. Once the job is done, the sensor can simply be washed away using hot water. “It could be recycled, since removal doesn’t damage the device,” says Huanyu Cheng, who led the research. “And, importantly, removal doesn’t damage the skin, either. That’s especially important for people with sensitive skin, like the elderly and babies. The device can be useful without being an extra burden to the person using it or to the environment.”

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As it continues to improve its device, the team hopes to tailor the technology to monitor symptoms of COVID-19.

 The research was published in the journal ACS Applied Materials & Interfaces.

EDITOR’S COMMENT: The first thing that came to my mind were chemical (CWA/TIC0 and radiological sensors for first responders

The Alleged Plot in Michigan Isn’t an Anomaly. The Domestic Terrorism Threat Is Rising Source: http://www.homelandsecuritynewswire.com/dr20201013-the-alleged-plot-in-michigan-isn-t-an-anomaly-the-domestic- terrorism-threat-is-rising

Oct 13 – Last week’s announcement by federal authorities that six men had been arrested and charged with conspiracy to kidnap Michigan Gov. Gretchen Whitmer (D) (seven other individuals were arrested on related state charges) is a chilling example of the evolving domestic terrorist threat facing America. Kevin K. McAleenan, the former acting secretary of the Department of Homeland Security, and Thomas K. Plofchan III, the former counterterrorism adviser to the secretary, write that the arrests in Michigan represent “one of the most significant incidents highlighting law enforcement concerns that domestic extremists.” They add that “the predominant terrorist threat at home today is increasingly domestic in nature,” and that “Within the domestic terrorist threat landscape, racially and ethnically motivated violent extremists, and specifically white-supremacist extremists, represent the ‘most persistent and lethal threat,’ according to the recent DHS threat assessment.”

What a surprise! Source: https://www.meforum.org/61648/turkey-rekindles-the-armenian-genocide

Piracy, illegal dumping or sea crime? Source: https://news.yahoo.com/fire-fire-fire-a-ship-captain-faces-prosecution-after-a-slaughter-at-sea-210416319.html

White House Strategy Names 20 Emerging Technologies Crucial to National Security Source: https://www.nextgov.com/emerging-tech/2020/10/white-house-strategy-names-20-emerging-technologies-crucial-national- security/169293/

Oct 15 – The White House on Thursday rolled out a new strategy to obtain and retain global superiority in world-changing emerging technologies like artificial intelligence, data science and space tech, among others. While the U.S. has been a technology leader for much of the last century, that supremacy is being challenged today. “American leadership in [science and technology] faces growing challenges from strategic competitors, who recognize the benefits of S&T and are organizing massive human and capital resources on a national scale to take the lead in areas with long-term consequences,” according to the newly released National Strategy for Critical and Emerging Technologies. The document promotes a “market-oriented approach” rather than “state-directed models,” which the administration claims “produce waste and disincentivize innovation.” At the same time, the strategy enables the government to “protect ourselves from unfair competition,” citing China and Russia, specifically. “Strategic competitors, such as the [People’s Republic of China] and Russia, have adopted deliberate whole-of-government C&ET efforts and are making large and strategic investments to take the lead,” the strategy states. “As a result, America’s lead in certain

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C&ET sectors is declining. The United States will take meaningful action to reverse this trend.” The strategy—developed by the National Security Council—melds with the National Security Strategy and “unifies the United States government effort to maintain worldwide C&ET leadership with our allies and partners,” it states. The administration plans to bucket each critical technology into one of three tiers, putting the full force of the government behind the highest priority areas. For remaining technologies, the government will “contribute as a peer with allies and partners in high-priority C&ET areas, and manage technology risk in other C&ET areas,” the strategy states. The document does not specify where the specific technologies listed fall in this hierarchy. The strategy is molded around two pillars: promote the national security innovation base and protect technology advantage. Each pillar includes a litany of actions—13 and nine, respectively—geared toward speeding the innovation process and walling it off from foreign influence. Under the first pillar, the administration plans to focus on building the workforce and investor base in the private sector to sustain advanced, quality research and development. The pillar also includes prioritizing R&D in federal budgets, despite the administration’s yearly proposals to cut civilian government R&D spending by tens of billions of dollars. The first part of the strategy also calls for more use of emerging tech by government agencies, whether developed in-house or purchased from commercial vendors, and encourages “state and local governments to adopt similar actions.” The second pillar focuses on preventing foreign adversaries from getting an advantage off of innovations led by the U.S. and its partners. The priority actions under this pillar include creating and supporting international norms against theft of intellectual property, increasing security in the R&D pipeline and restricting exports of specific technologies to adversarial countries. The strategy includes an initial list of 20 technologies identified as critical by the National Security Council: • Advanced computing • Advanced conventional weapons technologies • Advanced engineering materials • Advanced manufacturing • Advanced sensing • Aero-engine technologies • Agricultural technologies • Artificial intelligence • Autonomous systems • Biotechnologies • Chemical, biological, radiological and nuclear mitigation technologies • Communication and networking technologies • Data science and storage • Distributed ledger technologies • Energy technologies • Human-machine interfaces • Medical and public health technologies • Quantum information science • Semiconductors and microelectronics • Space technologies National Security Council staff plan to update the list annually, including garnering feedback from federal agencies on needs, uses and priorities.

Teacher decapitated in Paris suburb, France's anti-terror prosecutor says Source: https://edition.cnn.com/2020/10/16/europe/paris-suburb-man-decapitated-intl/index.html

Oct 17 – A 18yo Chechen teenager decapitated a schoolteacher in a suburb of Paris on Friday afternoon and was later shot dead by police, France's anti-terror prosecutor told CNN.

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The victim's body was found in Éragny-sur-Oise, northwest of the French capital, according to the French National Anti-Terror Prosecutor's office. The prosecutor's office confirmed that the attacker was killed by police in the same area. The victim was a 47yo history teacher at a secondary school in the region of Conflans- Sainte-Honorine, according to the prosecutor's office. The teacher recently showed controversial caricatures depicting the Prophet Mohammed to his students, according to multiple French media outlets, including CNN affiliate BFMTV. According to French newspaper Le Monde, some Muslim parents complained to the school about the murdered teacher's decision to use one or more of the cartoons as part of a discussion about the Charlie Hebdo attacks. The teacher was "killed because he was teaching students freedom of speech, the freedom to believe and not believe," President Macron said.

France's litany of deadly attacks Here are some of the attacks that have taken place in France over the past few years: ⚫ Two people were stabbed and wounded in Paris on Sept. 25 this year near the former offices of the Charlie Hebdo satirical magazine, where Islamist militants carried out a deadly attack in 2015. A man originally from Pakistan was arrested over the attack. ⚫ Oct. 3, 2019 – Mickael Harpon, a 45-year-old IT specialist with security clearance to work in the Paris police headquarters, killed three police officers and one civilian employee before being shot dead by police. He had converted to Islam about 10 years earlier. ⚫ March 23, 2018 – A gunman kills three people in southwestern France after holding up a car, firing on police and taking hostages in a supermarket, screaming 'Allahu Akbar'. Security forces storm the building and kill him. ⚫ July 26, 2016 – Two attackers kill a priest and seriously wound another hostage in a church in northern France before being shot dead by French police. Francois Hollande, who was France's president at the time, says the two hostage-takers had pledged allegiance to Islamic State. ⚫ July 14, 2016 – A gunman drives a heavy truck into a crowd celebrating Bastille Day in the French city of Nice, killing 86 people and injuring scores more in an attack claimed by Islamic State. The attacker is identified as a Tunisian-born Frenchman. ⚫ June 14, 2016 – A Frenchman of Moroccan origin stabs a police commander to death outside his home in a Paris suburb and kills his partner, who also worked for the police. The attacker told police negotiators during a siege that he was answering an appeal by Islamic State. ⚫ Nov. 13, 2015 – Paris is rocked by multiple, near simultaneous gun-and-bomb attacks on entertainment sites around the city, in which 130 people are killed and 368 are wounded. Islamic State says it was responsible for the attacks. Two of the 10 known perpetrators were Belgian citizens and three others were French. ⚫ Jan. 7-9, 2015 – Two Islamist militants break into an editorial meeting of satirical weekly Charlie Hebdo on Jan. 7 and rake it with bullets, killing 12 people. Another militant kills a policewoman the next day and takes hostages at a supermarket on Jan. 9, killing four before police shoot him dead.

I dared to criticise Hezbollah on Twitter, and paid a heavy price By Luna Safwan Source: https://www.thenationalnews.com/opinion/comment/i-dared-to-criticise-hezbollah-on-twitter-and-paid-a-heavy-price-1.1094171

… This is what happened to me on the week of October 1, after I tweeted a picture of the Hezbollah flag with accompanying text reading “the elephant in the room” to suggest that Hezbollah’s overpowering influence is a subject that the Lebanese often refrain from talking about. I tweeted it in the context of a discussion about how party politics in Lebanon is crippling public services and will lead the country to further collapse. I received plenty of criticism, including some angry comments. None of this was unusual, given that I am an active writer. I am also very opinionated, expressing what I think openly, and I am a firm believer in my right to say what I want to say as a woman journalist reporting from the field.

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 Read the full article at source’s URL.

Luna Safwan is a Lebanese freelance journalist who works on press freedom.

Weapons of the Islamic State Source: https://www.conflictarm.com/reports/weapons-of-the-islamic-state/

This Dec 2017 report is the result of more than three years of field investigation into Islamic State supply chains. It presents an analysis of more than 40,000 items recovered from the group between 2014 and 2017. These items encompass weapons, ammunition, and the traceable components and chemical

precursors used by the group to manufacture improvised explosive devices.

EDITOR’S COMMENT: It is interesting to read the origin of the weapons and munition used by the IS and one can only imagine the pathways used in order to aquire/purchase them. Although this is a 2017 report, it makes crystal clear why, in our days (Oct 2020), the EU, USA, Russia and China are doing nothing to stop or control Turkey’s aggressiveness in Libya, Syria, Armenia, Cyprus and Greece. Geld über alles!

Man Denied German Citizenship for Refusing to Shake Woman's Hand Source: http://www.homelandsecuritynewswire.com/dr20201019-man-denied-german-citizenship-for-refusing-to-shake-womans- hand

Oct 19 – The application of a Lebanese doctor for German citizenship was denied after he refused to shake a woman’s hand. The doctor passed the German naturalization test, but refused to shake hands with the official – a woman — who handed him his citizenship certificate.

The court ruled that a refusal to shake a woman’s hand indicates that the man rejected “integration into German living conditions.”

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Beheading in France and the rise of radical Islam in Europe By Kartikeya Sharma Source: https://www.wionews.com/opinions-blogs/beheading-in-france-and-the-rise-of-radical-islam-in-europe-335972

Oct 17 – It is a paradox as to how a person can loathe and hate the same society which he or she desires to be part of. Europe is battling with this paradox where the first- and second-generation immigrants from Muslim countries have led to rise in Islamic terrorism. Rise of radical Islam in Europe has come in many colours and shades, but France remains an exception where Islamic terror attacks continue unabated. The latest being beheading of a teacher who apparently showed caricature of Prophet Mohammad to his students. The irony is that he would ask Muslim students in his class to leave lest he hurt their religious feelings. What he practised was quintessentially French like secularism which separates the state from the church, other values also define what it means to be a French. On a lighter note, it can be sweet breakfast in the morning and on a serious side it can be French commitment towards the ideal of freedom of speech and expression which does not entertain the idea of blasphemy. French society and law will hold in contempt discriminatory views, but they do hold the right of an individual to ridicule and criticise very strongly. It is a modern French value apart from many others which emanate from manners to customs to food. Does this make Islam incompatible with modern values of liberal democracy? Does Islam want its version of liberal democracy to be implemented on modern European democracies? Are Islamic values incompatible with the ideals of the French revolution and ideas associated with it? Fundamentally, today’s Europe apart from many other differences does not entertain the idea of blasphemy. A point to be noted is that most of the Islamic terror cases in Europe do not involve the Madrasas. Those involved in radical Islam are not all necessarily poor people. They come from varied backgrounds. Two schools of thought exist in Europe over Islamic terrorism. One school is of the view that radicalisation has witnessed Islamisation and another locates protest and violence in disempowerment, poverty and dislocation. The former believes that Islamic violence is a product of modernity and has nothing to do with essential nature of Islam and what we witness today is modern civilization reinventing Islam in which participants have less to do with the book and more to do with the homogenous Muslim identity which is not located in a common culture. The other school argues that Islamic radicalism should be seen from the perspective of disempowerment in Western cities and a sense of solace and brotherhood being received from an idea of Ummah. With the same logic, racist and right-wing violence can be explained which too wants to alter the character of the state by subversion or capture. In my view, there exists a third position. Europe over the years has been able to come to terms with the idea of blasphemy. It has been able to rest its bloody history of inquisitions and witch-hunting when hundreds of women were burnt in the name of one supreme God. Europe over a period of time witnessed literary, cultural and sexual revolution which is not the case with Islamic societies. Early Christianity considered marriage only for procreation and not pleasure which was not the case with Islam which within its ambit provided for sexual appetite. This has often led to the caricature of lustful Muslim men but is a matter of another debate. In the last 80 years, Europe has witnessed intense waves of immigration because of multiple reasons. The first wave was during the post World War-II era when Europe was falling short of hands and required men to run industries. The second wave took place as expertise was required and had to be imported and third took place because of the dislocation of West Asian states. This changing demography in countries like Sweden and France, despite welcoming them in the country, cultural assimilation did not take place. Immigrants can be modern by dress but not through values and tastes as incompatibility remains. Whether a woman being beaten in France for wearing a short skirt to violence in Norway over disrespect to one's own religion are all new. They will continue to exist till values of the adopted countries are not inculcated properly. Islamisation of Europe may be a far-fetched reality but the clash between the native values and self- imbibed imagination of Islam in danger and religion being affronted remains the biggest challenge to a liberal Europe. In the 1970s, hijab, purdah and head scarves were seen as a symbol of patriarchy and gender discrimination. Women fought against it the world over and won the battle. Today in

www.cbrne-terrorism-newsletter.com 37 HZS C2BRNE DIARY – October 2020 places like the Americas and Europe, head scarves and purdah are back as a symbol of cultural relativism and diversity. Let’s not fool ourselves. There are things which need to be kept at bay and first being the idea of blasphemy and punishment for it. Hinduism has been able to deal with this problem by building laws on prevalent caste practices. Christianity has been able to deal in parts by cultural shift in popular imagination, but Islam has not been able to inject this change. Till the idea to entertain and respect the idea of blasphemy remains, violence will remain justified and would continue to express in multiple forms in the name of Jihad.

Kartikeya Sharma is Political Editor at WION (India).

The Royal Navy is testing jet pack assault teams Source: https://www.wearethemighty.com/military-culture/royal-navy-jetpack-assault-teams

Oct 18 – For decades, science fiction has been telling us that jet packs are right around the corner. But, while it seems there'll still be some time before any of us are using them to get to work, the UK and US have been experimenting with jet suits for a number of applications, including defense.

Of course, this isn't the first time Gravity Industries' jet packs have been spotted flying around Royal Navy ships. That's fitting, seeing as Gravity Industries' founder Richard Browning served in the British Royal Marines prior to beginning his new life as a jet pack mogul. Last year, he had the opportunity to fly his 5-engine jet pack suit around the pride of the Royal Navy, the HMS Queen Elizabeth. While the Royal Navy hasn't announced any plans to adopt these jet packs for military purposes, both the Royal and U.S. Navies have acknowledged that they've been in contact with Gravity Industries. According to Browning himself, he's already met with members of the U.S. Special Operations command — specifically, the Navy SEALs — to discuss what capabilities his jet packs could offer. Last month, the Great North Air Ambulance Service (GNAAS), a UK-based charity that provides helicopter emergency services, began testing jet suits from Gravity Industries to see if they might allow paramedics to fly directly up to hard-to-reach locations where hikers and mountain climbers find themselves injured.

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As GNAAS pointed out, "The undulating peaks and valleys can often mean the helicopter is unable to safely land close to the casualty, forcing travel by vehicle or foot." That's not optimal for emergency situations and could potentially even put rescue workers in danger. That's where these jet packs could come in.

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"In a jet pack, what might have taken up to an hour to reach the patient may only take a few minutes, and that could mean the difference between life and death," GNAAS director of operations Andy Mawson explained.

EDITOR’S COMMENT: When I wrote about the jet pack in the Preparedness Chapter (p.40), I thought that the Iron Man jet pack was an innovative tool for healthcare providers that have to intervene in remote places in order to save lives. As always, the military is interested in anything that could serve their purposes and missions. If the jet pack is not making any noise this is good. If the flames [?] of the turbo engines cannot be seen in the night, this is good. For the time being, these two problems have not been solved or even addressed. On the other hand, let us keep an open eye because the time that people could fly solo is not that far away – good people and bad people!

ISIS Magazine Publishes Photo of French Teacher’s Head, Calls for More Attacks on Free Expression By Bridget Johnson Source: https://www.hstoday.us/subject-matter-areas/counterterrorism/isis-magazine-publishes-photo-of-french-teachers-head- calls-for-more-attacks-on-free-expression/

Oct 19 – A new issue of the ISIS magazine that in recent weeks encouraged the murder of those accused of blasphemy contains a full-page graphic urging more attacks and showing the severed head of the French teacher killed Friday. Samuel Paty, 47, received death threats on social media after his recent class studying freedom of expression in the context of the Charlie Hebdo Muhammad cartoons. The history teacher had asked Muslim students to leave the room before he showed the caricatures so that they would not be offended. One Muslim student stayed and told her parents, who filed a complaint against Paty; the father posted a video on social media railing against Paty, stating the school’s address, and calling for “mobilization” against the teacher.

Abdullakh Anzorov, an 18-year-old Chechen with a minor criminal history who had lived in France from the age of 6, traveled 60 miles from the Normandy town of Évreux to the school in Conflans-Sainte-Honorine. He had no connection to Paty and reportedly asked students

www.cbrne-terrorism-newsletter.com 40 HZS C2BRNE DIARY – October 2020 outside of the school to identify the teacher. Anzorov then followed Paty as he walked home from work, stabbing and beheading him with a 12-inch knife. Before police arrived at the scene, Anzorov uploaded video and photos of the attack to other ISIS supporters. A Twitter post attributed to Anzorov included a severed head photo and stated, “In the name of Allah, the Most Gracious, the Most Merciful. From Abdullah, the Servant of Allah, To Macron, the leader of the infidels, I executed one of your hellhounds who dared to belittle Mohammed, calm his fellows before you are inflicted harsh punishment.” Anzorov was shot to death by police after he reportedly fired an airgun at officers and tried to stab them. In August, an English-language monthly magazine produced by ISIS supporters urged followers to “race” to emulate the Charlie Hebdo attack, arguing that governments aren’t doing enough to punish those viewed by the terror group as blasphemers. “The Voice of Hind,” released online by ISIS supporters in India, subsequently responded swiftly to the Paris attacks with a full-page graphic on the last page of the newest issue released today. “If your freedom of expression doesn’t stop you from criticizing prophet Muhammad PBUH then our swords will not stop defending the honour of prophet Muhammad PBUH,” the image said, with a cutout photo of Paty’s head below a graphic of a sword. The magazine’s earlier issue told Muslims that “the governments you live under are providing full support and protection to every person who attacks our beloved prophet, under the pretext of freedom of expression.” The article then called the 2015 Charlie Hebdo mass shooting, in which brothers Chérif and Saïd Kouachi killed 12 people at the satirical magazine’s offices, attack an operation “with Faith and riffles [sp]” to “wreak havoc in the broad daylight to avenge the Messenger (PBUH) for being abused by this newspaper.” The Kouachis and “all those brothers who come out” to attack accused blasphemers are “leaving a clear path for others to follow,” the magazine stated, as “we cannot expect the disbelieving and apostate governments to carry out the punishment for the blasphemy prescribed by Islam.” That punishment, the article continued, is “nothing but death,” and followers should “race to one another to carry out this obligation.” “If we do not become forceful, then the assaults on our religion… will continue,” the text stated, calling on supporters to “take revenge on each and every one who has insulted our beloved Messenger (PBUH).” Subsequently, on Sept. 11, al-Qaeda in the Arabian Peninsula issued a message calling on Muslims living in France to conduct attacks, referencing the Charlie Hebdo attack. AQAP claimed the 2015 attack. Fourteen suspects accused of aiding the Kouachis’ plot went on trial last month. Since Paty’s murder, French police have arrested four students, four relatives of the killer, the father who launched the social media campaign against Paty, and an Islamist preacher who, according to Interior Minister Gérald Darmanin, declared a fatwa against Paty.

Bridget Johnson is the Managing Editor for Homeland Security Today.

ISIS on Fast Track to Recovery as World Grapples with Pandemic Source: https://www.hstoday.us/subject-matter-areas/counterterrorism/isis-on-fast-track-to-recovery-as-world-grapples-with-pandemic/

Oct 18 – Parallel to the spread of the coronavirus around the world, the Islamic state group is expanding its activities, primarily in the area connecting Iraq and Syria but also in its other “provinces” across the globe, the School of Political Sciences at the University of Haifa and the Begin- Sadat Center for Strategic Studies at Bar-Ilan University said in a recent study. According to the study, waves of terror attacks between May and August of 2020 killed and wounded hundreds of people. In mid-May, over 200 attacks were carried out in various provinces. In late July and early August, more than 500 people were either killed or wounded in over 130 attacks. In the first weeks of August, ISIS terrorists perpetrated more than 100 attacks across the globe, killing and wounding some 400 people.

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Desert Drift, Declining Deadliness: Understanding the Evolution of AQIM’s Suicide Bombings By Jason Warner, Ellen Chapin, Caleb Weiss Source: https://ctc.usma.edu/wp-content/uploads/2020/10/Desert-Drift-Declining-Deadliness.pdf

Oct15 – For the past several years, jihadi violence perpetrated by al-Qa`ida in the Islamic Maghreb (AQIM) and its affiliated groups like Jama’at Nusrat al-Islam wal Muslimin (JNIM) has contributed to renewed insecurity in the Sahara and Sahel. Despite the widespread violence that has emerged, few studies have focused on AQIM and its affiliates’ broader profiles of violence generally, or their use of specific tactics more acutely. This report examines how AQIM and its affiliated groups have deployed suicide bombers over the past 13 years. Using a unique dataset compiled by the CTC detailing the breadth of AQIM and its sundry affiliated groups’ use of suicide bombers from March 2007 to September 2020, this report offers the most comprehensive view to date of the groups’ use of the tactic. Among other findings, it underlines the existence of AQIM’s “desert drift:” the very clear shift in theaters of operation of AQIM’s suicide bombers from North Africa between 2007 and 2012 (focused primarily in Algeria, where it focused on police and domestic military targets) to the Sahel from 2013 to 2020 (focused primarily in Mali, where it targeted international peacekeepers). Using AQIM’s “desert drift” as a dividing point between two distinct suicide bombing campaigns, the report then compares various dimensions of AQIM and its affiliates’ suicide bombing efforts across these two campaigns, including comparative metrics on lethality, injuriousness, geographies, demographics of bombers’ age and gender, targeting tendencies, use of “teams” of bombers, and patterns of failure. In the main, it shows that despite being a long- used tactic by an increasingly pernicious group, AQIM’s use of suicide bombing has declined in prevalence, deadliness, and efficacy in the aftermath of its “desert drift.” Given these findings, the authors seek to provide new insight into how policymakers and academics understand the historical and contemporary threats posed by AQIM and its affiliates. In tracking one tactical choice of the group—suicide bombings—the authors also seek to provide a detailed analysis of how al-Qa`ida has manifested in the Sahel in a distinct form, tailoring its attacks profile to meet its evolving goals. Through these new insights, the report endeavors to provide new perspectives that will inform any response to insecurity in these regions and beyond.

Jason Warner is an Assistant Professor in the Department of Social Sciences at the U.S. Military Academy – West Point, where he also directs Africa research activities in the Combating Terrorism Center. Ellen Chapin is a Ph.D. student in political science at Stanford University and serves as Speechwriter to General (Ret) Stan McChrystal. Her research focuses on global jihadi and domestic far-right extremism. Caleb Weiss is a research analyst and contributor to FDD’s Long War Journal, where he focuses on political violence and jihadism in the Middle East and Africa, and a Master of Arts in Law and Diplomacy candidate at The Fletcher School at Tufts University.

The New Age of Police Reform – Part I By Joseph W. Trindal Source: https://www.domesticpreparedness.com/resilience/the-new-age-of-police-reform-part-i/

Oct 21 – As if the first two decades of the 21st century were not dynamic enough, the first year of the third decade has impacted every person on multiple levels. While the viral pandemic continues to affect every profession, health care professionals around the world are dramatically reassessing their service delivery models. The pandemic indiscriminately sweeps across geopolitical borders, similarly the strong call for social justice reforms is

www.cbrne-terrorism-newsletter.com 42 HZS C2BRNE DIARY – October 2020 traversing the globe demanding action and change. For example, within hours of the tragic death of George Floyd in Minneapolis, Minnesota, demonstrations insisting on social justice reform emerged in cities worldwide. The energy behind these demonstrations and even violent protests continue to fuel police reform measures beyond the U.S. In a series of four articles, the DomPrep Journal will examine the foremost initiatives of modern police reform in America. Much of the world looks to the U.S. as an innovative leader in democratic policing. Therefore, the modern U.S. police reform movement will shape global democratic policing for decades to come. Calls for reform range from sound initiatives – building upon collaboration and inclusion – to extreme calls for eliminating public police services all together. This article, together with other articles in this series, will cover a select number of the most prominent or most promising police reform initiatives. It is important to recognize that police reform is a continuing journey of improving and right-sizing the police-citizen coexistence. There are lessons to be drawn from the origins of modern democratic policing that hold relevance to 21st century reforms.

The Original Democratic Police Reform Movement The foundation of values in policing democratic societies trace its origins to a reform movement in London in the 1820s. At that time, Home Secretary Sir Robert Peel led a landmark transition from privatization to public policing in order to establish professional standards and effectiveness, which had to be balanced against public consent of policing. Peel is credited as the father of modern policing with the passage of the Metropolitan Police Act of 1829. The importance of professionalizing police service was reflected in an enormous record of instructions, orders, and memoranda issued to govern police service. In just over 30 years, instructions to police occupied 22 volumes that are historically preserved by the London Metropolitan police. The lessons drawn from creation of the London Metropolitan Police (Met) emphasize community and police cohesion. Early police service performance metrics at the Met emphasized crime prevention over arrests and enforcement action. The Nine Peelian Principles of Police Service, drawn from those early instructions, still remain relevant in the 21st century, as Americans continue the journey of improving their police service approach. Essentially, there are four pillars of the modern British policing model, which share relevance with U.S. police reform today: (1) consent of the public, (2) accountability to the rule of law, (3) restrained use of force, and (4) independence from political influence. Considering these core pillars, police services in the U.S. – as in other democracies – are presented with inherent friction between “consent and balance” and “independence and accountability.” Four pillars of U.S. police reform – past and present – include public consent, rule of law, restrained use of force, and independence from political influence.

Reorganization & Fiscal Reprioritization In January 2020, the Chicago Police Department (CPD) announced sweeping reorganizational initiatives under Interim Police Chief Charlie Beck (former Los Angeles Chief of Police). CPD’s steps include reallocation of personnel such that sworn officers previously working in administrative and support positions are returned to field assignments to perform patrol duties. This provides greater police connection with communities in preventing and deterring crime. Homicide Division detective assignments have also been decentralized with the added overall emphasis on precinct-based command accountability. Beck’s expectations are that decentralizing homicide detectives to assigned areas will increase investigative effectiveness resulting in higher and faster case clearance rates through closer community connections. One of CPD’s most progressive restructuring initiatives is the creation of the Office of Constitutional Policing and Reform, placed under the command of Deputy Superintendent Barbara West. In advancing CPD’s implementation of the 2019 Chicago Police Consent Decree, the Office of Constitutional Policing and Reform is organizationally on par with the Office of Operations as the two main sections in CPD. The Los Angeles Police Department (CA) also has an Office of Constitutional Policing and Policy as one of a number of organizational reforms under the 2001 Los Angeles Police Consent Decree and other initiatives. Other agencies have taken similar measures, for example, Long Beach Police Department (CA) announced in August 2020 the creation of the Office of Constitutional Policing to “rethink traditional policing in a manner that will help implement equity, justice, and constitutional public safety.” Additionally, CPD’s Use of Force Policy, updated 29 February 2020, states that “the Department’s highest priority is the sanctity of human life.” In keeping with the Peelian principles, the revised policy adds that “a strong partnership with the public is essential for effective law enforcement.” CPD’s revised policy also requires CPD officers to “ensure compliance by themselves and other members” of CPD, adding further instructions to “act to intervene” and “immediately” report observed excessive force of fellow officers. Coinciding with New York’s Office of Attorney General’s July 2020 release of the Preliminary Report on the New York City Police Department’s Response to Demonstrations Following the Death of George Floyd, New York Attorney General Letitia James called for moving

www.cbrne-terrorism-newsletter.com 43 HZS C2BRNE DIARY – October 2020 oversight of the New York Police Department (NYPD), the largest U.S. municipal police department, from the purview of the mayor to an independent commission. In June 2020, the New York City Council voted to reallocate $1 billion from NYPD’s nearly $6 billion budget. To put this example in context, while enacted amid calls for defunding NYPD, NYC reported a $9 billion loss in revenue due to COVID, and the council’s passage of an $88.1 billion 2021 budget was a 7.6% reduction from Mayor DeBlasio’s original $95.3 billion budget request. As a result, NYPD canceled its July academy class and is under a hiring freeze, as are many other city departments, except those performing health and safety responsibilities. Some like former Deputy Major Richard Buery Jr. criticized the NYPD cuts, tweeting that “these aren’t really cuts to NYPD and don’t reflect a fundamental shift in the nature of policing in NYC.” According to Forbes in August 2020, over a dozen other police departments have received budget cuts to their police services. Seattle’s City Council voted in September to override the mayor’s veto of immediate police department budget cuts. Council’s budget authorization for Seattle Police Department (SPD) projects workforce reduction through layoffs and attrition of nearly 100 by the end of 2020. Subsequent to the council’s vote, then Chief Carmen Best announced her retirement. Best pointed out that the council’s salary cuts and layoffs would inflict the most harm on younger, more diverse officers due to the seniority rules. Seattle’s cuts to SPD also impact school resource officer programs and other specialized units, like harbor patrol and mounted (equestrian) patrols. As part of Seattle’s Navigation Teams, an interdepartmental program operated in cooperation with Seattle’s Human Services Department, specially trained police help the homeless population relocate from the streets to shelters and into a variety of social services.

Department of Treasury, IRS Criminal Investigations Special Agents – Public Domain

Many studies have shown higher incidence of mental illness among homeless populations. Homeless adults with mental illness are more likely to engage in criminal behavior and become crime victims than adults with mental illness in shelters. Seattle’s plan for eliminating the Navigation Teams program, of which police participation has been critically viewed by some as street sweeping and retraumatizing homeless, also affects Seattle’s Human Services participation, thereby providing no alternative redirection assistance to this vulnerable population. U.S. Attorney General William Barr issued a statement regarding Chief Best’s abrupt resignation commending her on her dedication while acknowledging her frustration. The attorney general’s press release also admonished state and local governments, “This experience should be a lesson to state and local leaders about the real costs of irresponsible proposals to defund the police.” Los Angeles Police Department (LAPD) is facing funding reductions that will diminish the nation’s second largest police department to 2007 staffing levels. Reducing police officers on patrol assignments increases response time and adversely impacts crime prevention through patrol presence. These reductions disproportionately affect socioeconomically disadvantaged communities. Resource constraints, like those imposed on LAPD and other police departments, require organizational realignment to operate within available resources. During periods of budgetary austerity, police services can no longer be the solution to all problems. Public safety communications specialists (dispatchers) have limited resources available to direct an ever-growing number of calls for services. In 2019, LAPD responded to 20,757 mental health crisis related calls for service, most of which did not require enforcement action. To address the rise in mental health crisis calls, LAPD had created the Mental Evaluation Unit (MEU) comprised of officers specially trained as System-wide Mental Assessment Response Teams (SMART) paired with a clinician from the LA Department of Mental Health. Reduced LAPD workforce and availability to send

www.cbrne-terrorism-newsletter.com 44 HZS C2BRNE DIARY – October 2020 officers to specialized training, like the SMART program, will impact Los Angeles City’s ability to effectively address the nearly 21,000 mental health crisis calls help, which according to LAPD resulted in 456 weapons confiscations in 2019. In a September 2020 interview with Attorney General Barr, Chief Steven R. Casstevens, who is president of the International Association of Chiefs of Police, asked about the fiscal and resource austerity approach some communities are taking toward achieving police reform. The attorney general pointed out that defunding “is counterproductive and will lead to more victims.” The attorney general added that law enforcement agencies need to improve community-based and national messaging about law enforcement. In response to Casstevens’ question about the future of policing, the attorney general pointed out the realities of fiscal constraints facing all government levels of law enforcement. He added that recruiting and retention will be challenging. Community trust and respect are important aspects of attracting the best people to the police profession. Barr pointed out that the federal agencies’ support to state and local law enforcement in combatting violent crime is as important today as it was when he was attorney general in the early 1990s. He cited examples in which the U.S. Department of Justice’s (DOJ) Operation Legend, launched in July, has significantly reduced violent crime by applying federal interagency law enforcement personnel to work with state and local police in highly successful task force models.

Other Aspects of Current Police Reform Leading up to and catapulted by the George Floyd tragedy in Minnesota, the current drive for improving police service and reinspiring community trust is far more complex than just budgets or organizational structures. There was great debate 200 years ago in London about the risks of publicly funded police to citizen freedom. A year after the Metropolitan Police Act of 1829 with the creation of the London Metropolitan Police, there was a cry to abolish the police over militarization of policing and the lack of transparency eroding public trust in procedural justice, “let us institute a police system in the hands of the people.” In the second part of this series, the call for reforms in police hiring and promotion diversity and inclusion will be addressed. This important topic of current police reform initiatives also examines police connection with diverse communities, public trust, and restrained use of force.

As founder and president of Direct Action Resilience LLC, Joseph Trindal leads a team of retired federal, state, and local criminal justice officials providing consulting and training services to public and private sector organizations enhancing leadership, risk management, preparedness, and police services. He serves as a senior advisor to the U.S. Department of Justice, International Criminal Justice Training and Assistance Program (ICITAP) developing and leading delivery of programs that build post-conflict nations’ capabilities for democratic policing and applied modern investigative techniques. Himself a Marine Corps veteran, he holds degrees in police science and criminal justice. He has contributed to the Domestic Preparedness Journal since 2006 and is a member of the Preparedness Leadership Council.

EU will be modernized further with the future addition of a new member! Source: https://www.meforum.org/61675/turkish-islamism-and-child-sexual-abuse

The Violent Extremist Lifecycle: Lessons from Northern Ireland By Neil Ferguson and James W. McAuley Source: http://www.homelandsecuritynewswire.com/dr20201022-the-violent-extremist-lifecycle-lessons-from-northern-ireland

Oct 22 – A new guide, released by CREST, draws on a reanalysis of interview data from the 1980s and 1990s that explored the lifecycle phases among loyalist and republican paramilitaries from across Northern Ireland. It offers twelve lessons that are relevant not only to those working within the Northern Ireland context today but also to those working to reduce the threat from violent extremists elsewhere.

1. Involvement comes before ideology Being socialized within a family, friendship network and community that was sympathetic and supportive to particular armed groups or their goals was key to creating the conditions for people to gravitate towards armed extremist groups.

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These processes remain visible now. Disaffected republicans use antagonism around policing as a means of attracting support from new members, while the flag protests and perceptions of the erosion of unionist culture attract young unionists toward loyalism. While radicalization is often viewed as an ideological process, it may help to view it as a social process. It is the sense of belonging, affiliation and connectedness that begins the journey that leads to ideology. In other words, it is not ideological zeal which drives the individual into the arms of an extremist group, but the affinity with the group that drives the individual to the ideology.

2. Involvement can be a reaction to perceptions of injustice The young Northern Irish men and women who joined paramilitary groups consistently reported how they lacked any deep political or ideological understanding before they became involved with them. Instead, they were moved to become involved in response to perceptions of injustice, threats from the other community, or experiences of discrimination or violence from the other community or the British State, usually via the actions of the security forces.

3. Attractive alternatives can pull people away from involvement Family and social networks can push and pull in different directions: The same conditions that attract people to extremist groups can also pull people towards groups which can guide them away from extremism to more prosocial activities. Countermeasures to protect against engagement should therefore include the provision of alternative groups which are attractive to susceptible young people. Likewise, using role models to deliver pro-social messages via social and conventional media could help those vulnerable to threat and uncertainty from shifting towards extremist or populist outlooks.

4. Sustained involvement can lead to being bound to the group When people invest so much and suffer great loss for a group and its political goals, they can become fused with the group and fellow members. This process of encapsulation within the group reduces contact with the world outside and can lead to a risky shift towards greater extremism. This isolation promotes greater moral certainty about the group’s ambitions, feelings of empowerment and self-efficacy, coupled with increased dehumanization and moral disengagement that allows the justification of violence. This justification offers psychological protection against the negative mental health consequences related to engaging in organized killing, which is vitally important in the ability of the person to sustain their militant career.

5. Burn out and stress can push people to leave Engagement in extremist violence creates trauma for both the perpetrators and their victims. Consequently, burn out and stress are factors which play a role in pushing people to leave armed groups (if they have available routes out).

6. When violence is viewed as counterproductive, support for the alternative grows Those who sustained their membership in armed groups beyond the Good Friday Agreement viewed contemporaneous and past violence as an effective means to bring about social change for their community.

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Accordingly, when violence was viewed as counterproductive, futile or antisocial, support for non-violent or political action grew.

7. Imprisonment maintains extremism… Twenty to 30,000 Northern Irish loyalist and republican paramilitaries were incarcerated during the Troubles. Even today, issues around imprisonment and prison conditions are key factors in sustaining support among dissident republicans. For most interviewees, imprisonment involved being concentrated together on segregated wings with members of their particular armed group. These conditions created the space to develop relationships and strengthen activist identities, which sustained engagement.

8. … but also opens members up to political solutions Imprisonment also allowed a greater focus on longer-term strategies that shifted the focus away from violent solutions towards political solutions. This move, from reactive short-term strategies towards more sophisticated long-term political projects, was driven through engagement with education, group discussion, learning negotiation strategies and practical non-violent skills when resisting prison governance, and maintaining safe intergroup encounters within the prison walls. For many, prison was transformational and reflective of the post-traumatic growth witnessed in other settings. These findings demonstrate the importance of creating a prison environment which allows groups of extremists the necessary space and resources to be challenged, to reflect and explore their goals, and to imagine different strategies to obtain them. Once imprisoned exemplars begin to move in this direction, their status and prototypical image make them powerful influencers within the group to promote transformational change.

9. The motivations that lead to involvement in violence can also justify a move away from violence Some of the key motivations for making the move away from violence towards seeking a political settlement focused on the desire to create a shared future for Northern Ireland – to create an environment in which youth would not have to continue the cycle of violence, death and imprisonment they had endured. There was also a desire to rest, recuperate, and rebuild links with family, friends and the wider community that had been diminished through the all-pervading nature of being a paramilitary. Therefore, while kin ties and social networks play an important role in pulling people into paramilitary groups, they can also offer routes out.

10. Strategies aimed at challenging extremist ideologies are not necessary if the aim is to reduce violence It is unlikely that committed extremists will voluntarily weaken the bonds they have to their comrades and the group, or with the sacred values and associated religious, political, or ethno-nationalist ideologies they identify with. Therefore, creating strategies aimed at reducing a violent extremist’s identity to their group and ideology is difficult and unlikely to succeed. It is also unnecessary if the aim is to create the conditions for militants to simply desist from violence.

11. Desistance can be fostered by removing barriers to disengagement Helping an extremist to foster new relationships and identities through education and employment, and by rebuilding family bonds, can moderate the centrality of the extremist self. Just as an extremist’s identity is embedded within their wider collective or community identity, the strong bonds to the community which initiated their engagement in pro-group antisocial behavior can also support pro-group prosocial behavior. In other words, there is more you can do to help your community than pick up a rifle. A continued commitment to the community can therefore be harnessed to promote disengagement from extremist violence.

12. Reducing stigma and providing economic alternatives are key Many of the paramilitaries, and particularly the loyalist paramilitaries, felt stigmatized in post- agreement Northern Ireland. This stigma can have a negative impact on employment prospects, financial security, and both psychological and physical health. The relationship with stigma and extremism is complex and stigma may play a role in maintaining engagement, by leaving people with few options to leave.

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Likewise, it could make re-engagement more likely for those that have left militant groups if they cannot find legitimate means to support themselves and families. Alternatively, it could cause some to leave if they have options to join a group or create an identity with a better social status through family, education or employment. Therefore, reducing stigma, facilitating the rebuilding of relationships outside the organization, and providing opportunities for legal economic activity and self-development are central to desistance.

Neil Ferguson, Liverpool Hope University James W. McAuley, University of Huddersfield

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Novichok Creator Compares Nerve Agent to Nuclear Bomb Source: https://sputniknews.com/military/202009251080571618-novichok-creator-compares-nerve-agent-to-nuclear-bomb/

Sep 25 – The so-called ‘Novichok’ group of nerve agents, developed by the USSR during the Cold War, has made it into the news recently, with German authorities alleging that the weapons-grade poison was used to attack Russian opposition figure Alexei Navalny. In an extensive interview with Sputnik, the weapon’s creator revealed why such claims are absurd. The Novichok (‘Novice’ or ‘Newbie’) group of chemical weapons was created in response to US researchers’ work on binary chemical weapons agents, and its effectiveness is comparable to that of a nuclear bomb, Dr. Leonid Rink, the State Research Institute of Organic Chemistry & Technology researcher played a major role in the creation of the deadly weapon, has revealed. “Work began in the 1970s. Before that, in the USSR it was thought that it was not worth making binary weapons in which each of its components by itself is not dangerous. Indeed, we had sufficient arsenals for the storage of dangerous mono-substances spread over large areas of the country. But in the late 1970s, the United States adopted the first binary system. Then the Politburo made the decision to start work in this area. The choice fell on me,” Rink told Sputnik. According to the chemist, the initial development team was small, with only seven people total having access to all information about the ‘Novichok system’, and involved in testing at a chemical weapon testing facility in the town of Shikhany, about 850 km southeast of Moscow. The weapon’s creators were provided with a series of requirements, including the condition that the binary poison not be flammable, explosive, or subject to freezing, and that the weapons-grade poison’s deadly effects would dissipate shortly after use. Individually, the poison’s compounds were of such low toxicity that, in Rink’s words, one would “need to eat [them] by the spoonful in order to achieve some kind of effect.”

Deadliness Comparable to a Nuclear Bomb At the same time, Rink said that when combined, the compound poison’s deadliness is comparable to that of a nuclear bomb. “Novichok was much cheaper than a nuclear bomb, and in the event of its use, all of the enemy’s facilities and equipment would remain intact. All the buildings, all the equipment. All that would be needed would to be wash them down, and then they could be used for one’s own purposes,” the scientist explained, saying the weapons system was meant for use on the battlefield by the Soviet Army and to decompose after a short time. The Novichok system was a weapon of mass destruction, not the means to eliminate a single individual, Rink said. “To kill one person, there are means which are orders of magnitude more effective, which have a delayed toxicity for any planned period you wish: a week, longer, shorter. They can be used in such quantities that no one will ever find any traces of them,” he stressed. According to the researcher, Western governments found out about the existence of the Novichok programme after Vil Mirzayanov, a chromatographer tasked with preventing foreign intelligence services from identifying the molecules of poisonous chemicals, published articles and a book on the deadly agents in the early 1990s and fled to the United States. Characterizing Mirzayanov as a “terrorist” or “accomplice of terrorists,” Rink said he will one day be tried for his crime of providing would-be terrorists with the information on how to create ‘Novichok’ in a lab.

If Poisoned by Novichok, Navalny Would Be Dead Before Making It to His Plane Asked to comment on the recent allegations by the German government that Russian opposition figure Alexei Navalny was poisoned by Novichok, Rink dismissed the claims as ridiculous, and explained why. Firstly, he said, if Navalny had truly been poisoned by Novichok, he would have been dead in 10 minutes flat. “From the very first symptoms it would be minutes. Death would follow in 10 minutes.” Secondly, Rink noted, the possibility of actually detecting Novichok in Navalny’s system would be close to zero, given that the binary weapon is specifically designed to degrade immediately after use. “I think that Novichok itself would stop being detectable very quickly. But those metabolic products could remain in the body for some time. I doubt that anything could last two weeks though. I doubt that very much. Moreover, don’t forget that very little of the substance would actually be needed – such a small amount that its traces would be impossible to detect,” the scientist said. Rink clarified that roughly speaking, a thousandth of a milligram of the binary poison multiplied by a person’s weight in kilograms would be enough for deadly effect. Earlier, after Navalny’s Instagram account released a statement saying that Novichok had been found on drinking water bottles from the hotel where Navalny had been staying prior to

www.cbrne-terrorism-newsletter.com 50 HZS C2BRNE DIARY – October 2020 his hospitalization, Rink said that if the substance on the bottles was really the Soviet-made chemical agent, not just the opposition figure, but everyone who touched the bottles would have been killed. Rink also outlined the gruesome details of how the binary poison works and its symptoms, including pupillary constriction and intense muscle spasms. “These are substances which, due to the interruption of the nerve impulse, cause muscle convulsions, particularly of the eye muscles. In other words, eye muscles show a constriction of the pupil; it becomes practically invisible even with such small doses of Novichok that there is practically no poisoning. This symptom appears immediately,” he said. In this connection, Rink said, an analysis of photographs of Navalny before he got onto the plane, on the plane itself, in hospital and on the way to the second plane which took him to Germany shows that he could not have been poisoned by Novichok. “If Navalny was poisoned by Novichok, he would not have made it to any plane, if he drank something at the hotel, because his eyes would close and he would be unable to make it to a plane or anywhere else. I guarantee this 100 percent,” the chemical weapons expert said. Developed between the early 1970s and the early 1990s, the so-called Novichok group of military-grade nerve agents was found out about by Western countries following the publication of Mirzayanov’s work, and learned about in more detail after US chemical weapons experts began working at labs across the former Soviet Union in the 1990s. According to the New York Times, the US Army Corps of Engineers came in contact with Novichok during their work to decontaminate the Nukus Chemical Research Institute in Uzbekistan in 1999. Russia destroyed the last of its stocks of Soviet-era chemical weapons in 2017 under the supervision of the Organization for the Prohibition of Chemical Weapons, in accordance with its obligations under the Chemical Weapons Convention, which Moscow ratified in 1997. By comparison, despite its adoption of the CWC, the US has yet to destroy its own stocks of chemical weapons, with Washington currently projecting the complete elimination of the weapons class by 2023 after pushing back the deadline repeatedly.

Transport Canada Launches 2020 Emergency Response Guidebook Source: https://www.hstoday.us/subject-matter-areas/transportation/transport-canada-launches-2020-emergency-response-guidebook/

Sep 21 – Transport Canada has launched the Emergency Response Guidebook 2020 to assist first responders in quickly identifying the hazards of the materials when an accident involving dangerous goods occurs, and also to determine the best approach to address the situation. The 2020 edition of the Guidebook which is a joint publication by Transport Canada, the United States Department of Transportation, the Secretariat of Transport and Communications of Mexico and the CIQUIME (Centro de Informaciòn Quìmica para Emergencias) of Argentina. It is updated every four years. The 2020 edition includes updates such as: • information on how to use the safety recommendations and emergency response guides; • a comprehensive review of the guides for products and additional cautionary advice • an expansion of the glossary of new terms and definitions; • new sections on decontamination and heat induced tears on tank cars, and • new visual identifiers for quicker access to information. In addition to the Guidebook, Transport Canada supports emergency response and first responders through the Canadian Transport Emergency Centre, more commonly known as CANUTEC. It is one of the major safety programs Transport Canada delivers to promote the safe movement of people and goods throughout Canada, by providing a 24/7 service that assists first responders in handling dangerous goods emergencies. The Guidebook is available for free to certain groups such as municipal first responders, Transportation of Dangerous Goods inspectors, remedial measures specialists, and provincial inspectors. It is available as a hard copy and in various electronic formats on CANUTEC’s website. A mobile application is also available for IOS and Androids. It has been translated into other languages such as Hungarian, Dutch, German, Hebrew, Japanese, Russian, Italian, Polish, Korean, Chinese, Turkish, Portuguese, and Thai.

 Find out more about the Guidebook at Transport Canada

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CBRNe World | August 2012 Source:https://www.academia.edu/12119117/Medical_Aspects_of_Chemical_Weapons_Victims_of_Iran?auto=download&email_w ork_card=download-paper

EDITOR’S COMMENT: A good paper to read – I personally know both authors; they have deep first-hand knowledge of the subject matter and they medically support Iran-Iraq war victims on daily basis.

Operation Lewisite Source: https://s3-ap-southeast-2.amazonaws.com/awm- media/collection/AWM2020.8.197/bundled/AWM2020.8.197.pdf

A report covering the history of CW disposal by the British Commonwealth forces in the BCOF Occupation Area of Japan (1946).

pp. 1-223

United States Conducts Training to Identify and Respond to Use of Weapons of Mass Destruction for Assassination Source: https://www.state.gov/united-states-conducts-training-to-identify-and-respond-to-use-of-weapons-of-mass-destruction-for- assassination/

Oct 08 – This week, the United States conducted a virtual training with key international partners from across the globe to help first responders, scientists, and security officials detect and respond to incidents where the use of weapons of mass destruction (WMD) is suspected as a tool of assassination. Russia has a particularly notorious history of using WMD to target adversaries for assassination. This includes attempts to assassinate opposition politicians in Russia, dissidents and defectors abroad, and even citizens of other countries whose actions Russia disagrees with. The assassination attempt against Sergei Skripal in Salisbury, U.K. in 2018 was particularly notable, because it involved the first known use of a Novichok nerve agent that the Soviet Union developed in secret. And the Skripal incident is not unique. Just last month, according to chemical analysis by Germany, France, and Sweden, which was confirmed by the Organization for the Prohibition of Chemical Weapons, a Novichok agent was also used in the assassination

www.cbrne-terrorism-newsletter.com 52 HZS C2BRNE DIARY – October 2020 attempt of Russian opposition leader Aleksey Navalny. Addressing such threats are a significant international security priority. This virtual exercise provided a critical opportunity for key partners to work together as an international community to prevent, deter, and hold those accountable for attacks using WMD. This is the first in a series of bilateral and multilateral trainings sponsored by United States with key international partners to help address this common concern. The United States is committed to helping our partners around the world counter Russian malign activities, and looks forward to continuing to work with them to help recognize, attribute, and respond effectively to incidents where use of WMD as a tool of assassination is suspected.

Pakistan: Chemical weapons used to silence voices of activists in Balochistan and Sindh, alleges Dr Nazar Baloch By Manish Shukla Source: https://www.dnaindia.com/world/report-pakistan-chemical-weapons-to-silence-voices-of-activists-in-balochistan-and-sindh- alleges-dr-nazar-baloch-2848697

Oct 09 – Pakistan has been involved in war crimes, human rights violations and genocide for a long time but the level of barbarism and inhumanity depicted recently in Balochistan and Sindh are extremely shocking as thousands of Baloch nationalist activists have disappeared from Balochistan and hundreds of young Sindhi and Urdu-speaking local workers from Sindh have been abducted by Pakistani agencies. They remain traceless, supposedly kept in torture chambers for years. Furthermore, the Pakistani Army does not hand over the dead bodies of the Baloch activists who get killed in action by the Army. This is entirely unethical and in complete violation of international rules of war by itself. As per a recent disclosure by Baloch national leader Dr Allah Nazar Baloch, of using chemical weapons by the Pakistan Army reinforces the belief of their heinous acts. “Not handing over the dead bodies of martyrs to their families raises the suspicion that Pakistan had used chemical weapons," alleges Dr Nazar Baloch in a statement published on the news intervention portal. Baloch said that such barbarism of Pakistan makes the belief stronger that living a life within this state is an utmost humiliation and disgrace for the Baloch people. The relatives of the killed activists are put under threat when they ask for the body of their loved ones. One such family claims that their house was set on fire many times forcing them to live under the open sky for several days. Dead bodies of two killed Baloch nationalists were seen by relatives, being dragged by Pakistan Army and thrown in a pit without performing the last rites and proper funeral. Pakistan Army forces the family of the killed ones to accept some unidentifiable cemented graves as of their loved ones. “There have been apprehensions that China has been supplying such chemical and biological weapons to the Pakistan Army. It, however, remains unclear whether these supplies were completely developed final products or provided to run trials on the Baloch nationalist activists,” sources told Zee News. Apart from the unscrupulous use of chemical or biological weapons by Pakistan on the Baloch people fighting for their freedom, there are also suspicions that the forcibly abducted Baloch and Sindhi people are smuggled to China for conducting human trials of the chemical or biological weapons under preparation on them. Almost all of them die in the process and remain traceless for their loved ones forever. Such scandalous, atrocious and heartless acts of Pakistan Army, coupled with the impious efforts of Pakistan government to muffle the rising voices against their atrocities forced Dr Abdullah Haiwad, President of Afghan Governor's Assembly, to make a call to the international community, in both grief and anger, that “solution doesn’t lie in condoning attacks, the aim should be focused to remove Pakistan from the map that way terrorism will be wiped out altogether.” In a press conference in Kech district of Balochistan, the relatives of recently killed Baloch nationalist activists urged the international community and human rights bodies to conduct an autopsy on the bodies under their supervision. Despite being an Islamic country, a country where even “freedom of speech” is subjected to restrictions in the interest of the ‘glory of Islam’, and where the constitution prescribes death

www.cbrne-terrorism-newsletter.com 53 HZS C2BRNE DIARY – October 2020 for defiling Islam or its prophets, the dead bodies of Baloch fighters are dragged by Pakistan Army for miles, disgraced by burning and dumped in the ditches dug with tractors. This all is but an act to disguise the traces of the use of chemical and biological weapons. Further, the Army would also be under pressure to hide the source of the chemical and biological weapons. This is high time for the international bodies and human rights defenders to make the much-needed call against the monstrous acts of Pakistan by putting it under a rigorous scanner. It should also be made sure that resources spent by the Pakistan government to carry out such hideous acts are taken into due cognizance while deciding upon the fate of Pakistan during the upcoming FATF plenary in October.

Drink Me: The Kremlin’s Long, Evil History of Poisoning Its Enemies By Andrei Soldatov and Irina Borogan Source: https://newlinesmag.com/essays/drink-me-the-kremlins-long-evil-history-of-poisoning-its-enemies/

The drug was fugu poison. The Japanese use it for committing suicide. It comes from the sex organs of the Japanese globe-fish. Trust the Russians to use something no one’s ever heard of. – M, James Bond’s boss, on a Russian agent’s attempt to poison 007. From Ian Fleming’s Doctor No

Oct 04 – When German authorities announced that Russian opposition leader Alexei Navalny, then still in intensive care at the Charité hospital in Berlin, had been poisoned in Siberia with Novichok, a military-grade nerve agent, the Kremlin’s involvement became almost impossible to deny. Novichok, after all, was developed in the Soviet Union and it was notoriously used to try to assassinate Sergei Skripal, former Russian military intelligence officer turned British spy, just two years ago in the United Kingdom. The Russian authorities vehemently denied the German diagnosis, which struck many as illogical. Why use a bespoke toxin, which is internationally known as poison developed and deployed by the Russian government? Among criminals, there are only two types who deliberately leave traces of their handiwork, making law enforcement’s job of identifying and catching them all too easy. The first are psychopaths who have an irrational, subconscious desire to be caught. The second are mobsters who like to turn their murders into lessons or warnings to others that a similarly grim fate awaits them should they cross the line. The Kremlin’s track record of poisonings certainly doesn’t suggest anything irrational. The Russian tsars – arrogant, short-sighted and fairly unqualified – fought a desperate struggle for years with the revolutionaries who called themselves, proudly, terrorists or “bombists.” The tsars kept hanging them, or sending them to Siberia, or spying on them abroad. The one thing they didn’t do was poison these radicals. What elevated poisoning as a state assassination method in Russia was the Bolshevik regime. Vladimir Lenin inaugurated the program by proposing himself as its first victim: After suffering a debilitating stroke in 1922, the first leader of the Soviet Union asked his successor, Josef Stalin, for cyanide to commit suicide. Stalin refused. Four years later, in 1926, the Russian secret services launched the first poison laboratory, according to most historians, although some argue the laboratory was really established in 1921 under Lenin’s direct orders. As with the name of the Russian secret services themselves, the name of the laboratory changed over time; it was known variously as “Laboratory No. 12,” “Laboratory X,” or just “Camera.” It was headed by Professor Grigory Mairanovsky, a gaunt man with the sunken cheeks of an ascetic. His lab was attached to a group of assassins tasked with killing enemies of the regime. Over the years, Mairanovsky experimented with more than a dozen poisons, from thallium and sodium cyanide to colchicine, digitoxin, aconitine, strychnine and curare. In short order, the poisons were exported for use against Russian political exiles, starting with Gen. Alexander Kutepov, a tough anti-Bolshevik and a veteran of the Russian Civil War, and the head of the military wing of the anti-Soviet émigré organization ROVS (Russian All-Military Union). In January 1930, a bystander saw Kutepov snatched from the streets of Paris by four unknown assailants and injected with something; he was shuffled into a car and driven off, never to be seen or heard from again. Poison was also used inside Russia. In 1937, Camera came under the personal control of Genrikh Yagoda, the head of the NKVD (People’s Commissariat of Internal Affairs), the forerunner agency of the KGB. Yagoda had been a pharmacist before the October Revolution, so this new purview suited him well, albeit not long. Stalin soon had Yagoda arrested and accused, ironically, of poisoning several prominent Russians including Yagoda’s predecessor, Vyacheslav Menzhinsky, as well the famous Russian writer Maxim Gorky. Yagoda was promptly shot. Grigory Mairanovsky kept Camera in dark business throughout the decades that followed, testing poisons on many recourseless victims, including over 200 Gulag inmates. The list of victims also included an American, former Comintern agent Isaiah Oggins, who in 1939 had been sentenced to eight years in the gulag for supposed “anti-

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Soviet propaganda” (in reality, he was yet another victim of Stalin’s paranoia). Then, Mairanovsky, too, was purged in 1951. Although the Soviet secret services dispensed with Mairanovsky, they didn’t give up on his weapon of choice. In 1959, Stepan Bandera, leader of the Ukrainian independence movement, was shot on the streets of Munich with a bullet filled with a cyanide. It was a mere year after Ian Fleming’s sixth 007 novel, Doctor No, was published, which made ample use of Russian poison in its plot. (Not that the Kremlin was alone in trying to off its opponents this way; in 1960, the CIA had Fidel Castro’s cigar box tainted with a botulinum toxin, although the stogies in question never found their way to El Commandante’s lips.) By the height of the Cold War, a clear target pattern emerged in the Soviets’ use of nerve agents and chemical weapons, with political rivals, dissidents, defectors, exiles, and leaders of independence movements in Soviet republics, including one prominent Ukrainian priest, being wiped out with these toxins.

During the Soviet years, Russian science was touted as one of the greatest successes of the regime. Russian science was considered to be equal, if not superior, to that of the wealthy western nations. The Perversion of Knowledge, a history of Soviet science that focuses on its control by the KGB and the Communist Party, reveals the dark side of this glittering achievement. Based on the author’s firsthand experience as a Soviet scientist, and drawing on extensive Russian language sources not easily available to the Western reader, the book includes shocking new information on biomedical experimentation on humans as well as an examination of the pernicious effects of Trofim Lysenko’s pseudo- biology. Also included are many poignant case histories of those who collaborated and those who managed to resist, focusing on the moral choices and consequences. The text is accompanied by the author’s own translations of key archival materials, making this work an essential resource for all those with a serious interest in Russian history.

And the research never stopped. In 1978, a Bulgarian dissident, Georgi Markov, was famously killed after an assassin stuck an umbrella point into his leg, injecting him with a pellet filled with ricin, a poison found naturally in castor beans and therefore somewhat easy to manufacture, making its point of origin harder to uncover. (As this story was being written, a Canadian woman was arrested on charges of having sent ricin to U.S. President Donald Trump.) The KGB had given the pellet to its Bulgarian counterpart, the Committee for State Security. When the Soviet Union collapsed, the legacy of Camera appeared to be just that – a thing of the past. The 1990s were a bloody time for Russia – a Chechen separatist insurgency and the brutal repression of it, the gangland violence of organized criminals and billionaire oligarchs. It was a period of guns, bombs, and missiles, but not poisons. The lone exception to this rule involved Novichok, which was used against a Russian financier in a purely commercial dispute. The killers had bribed one of the scientists who’d formerly worked on the Soviet program to manufacture a small dose – the rare instance of a state actor being seconded by non-state actors to deploy the nerve agent. Everything changed when Vladimir Putin came to power. In the early 2000s, Russia was embroiled in its Second Chechen War – only this time the rebels were assisted in no small way by international jihadists. One of these was the infamous Emir Khattab, an Arab warlord who’d become public enemy number one for Russia’s FSB, the domestic security agency, which Putin had headed until becoming prime minister and then president. Khattab had been responsible for many terrorist attacks inside Russia, and his assassination became a matter of the highest state priority. In March 2002, he was hiding in the mountains of the North Caucasus, surrounded by his bodyguards, and was expecting a letter from Saudi Arabia. To prevent being tracked by the FSB, Khattab communicated only via couriers, much as Osama bin Laden later did in Pakistan. The FSB had recruited one of them and poisoned an intercepted letter with a nerve agent, whose toxins were released slowly upon contact. The letter was delivered. Khattab

www.cbrne-terrorism-newsletter.com 55 HZS C2BRNE DIARY – October 2020 opened it, read it, and threw it into a campfire. Three days later, he suddenly started foaming at the mouth. In a few hours, he was dead. This operation, distinct from prior Soviet models that typically involved direct engagement between assassin and victim, was a slow- burn hit, relying on double agents with an underground jihadist network. It was seemingly inspired by Mossad’s killing of Fatah or Hamas targets in Palestine. Indeed, officers from Vympel, the FSB’s elite special operation unit, told us how fascinated they were by the Israeli intelligence’s targeted assassination program. For a short while, it appeared that Russia would refashion Camera’s methodology into a tool of counterterrorism against religious fundamentalists, not as one of terrorism against ordinary citizens or political activists. That trajectory proved false. In 2003, Yuri Shchekochikhin, a member of the Russian parliament and the deputy editor of Novaya Gazeta, one of Russia’s most well-respected newspapers, was conducting a series of sensitive investigations into corruption within the FSB. He died suddenly from some mysterious intoxication at a hospital at the age of 53. Within two weeks, all his internal organs failed one by one, his skin came off in clumps, his hair fell out, and he said his entire body felt like it was on fire. Shchekochikhin had been in good health and fit condition. One of his friends who returned from his funeral told us how transformed he was from the toxin that killed him: His corpse was that of an old man. We were young journalists, but we knew that many of our colleagues were gunned down, stabbed, or blown up as retaliation for their reporting. None, however, had ever been poisoned before. It was a gruesome escalation against what was still a relatively independent Russian press, a way of telegraphing to critics of the wealthy and powerful that no longer would they just be murdered. Now they’d die horrible, agonizing deaths that would torment their friends and families. It was right out of Stalin’s textbook. The authorities didn’t even pretend to investigate Shchekochikhin’s killing. A criminal case was opened five years later and then quickly dropped. Officially, the journalist and Duma delegate died of “an allergy.” A year later, in 2003, Anna Politkovskaya, Shchekochikhin’s colleague at Novaya Gazeta and a muckraking opponent of Putin’s wars in the North Caucasus, was en route via plane to the city of Beslan, North Ossetia, after terrorists captured over a thousand people, most of them children, in a local school. It became one of the worst hostage crises of modern times, and it ended calamitously when Russian security forces stormed the building with tanks and heavy weapons. The incident left 334 of the hostages, including 186 children, dead. Politkovskaya had drunk a cup of tea on the plane and lost consciousness. It was widely assumed she’d been poisoned so as to stop her from reporting live from the massacre. She survived, only to be fatally shot outside her apartment building two years later. After that, Russia poisoning Russians became common practice again, although the substances used –radiological isotopes, synthetic nerve agents – were no longer designed to hide the perpetrators. Now they were designed to advertise them. The most powerful image of 2006 was the photograph of Alexander Litvinenko, an FSB whistleblower turned British agent, taken from the intensive care unit of University College Hospital in London. The dirty-blonde exile had already gone bald from exposure to polonium-210, a highly radioactive and extremely rare isotope. Litvinenko died three weeks later. Of the two FSB officers accused by the British government of assassinating him, one, Andrei Lugovoi, was elected to the Russian parliament and awarded a seat on its Security Committee, the body tasked with defining the rules for Russia’s intelligence agencies. According to Vil Mirzoyanov, the Soviet scientist who first exposed the existence of Novichok to the world, the option to restore the production of this bespoke family of nerve agents in some form or another was always there. Polonium, on the other hand, has never stopped being manufactured in Russia, guarded by the secret services, home of the lion’s share of it. While we were researching our book The Compatriots: The Brutal and Chaotic History of Russia’s Exiles, Émigrés, and Agents Abroad, it struck us that almost everyone we met – an oligarch in exile, an oligarch tamed by the Kremlin, a high-ranking priest of the Russian Orthodox Church – mentioned Novichok. They’d all evidently come to the conclusion that, from now on, they couldn’t rule out being killed with it. Poisoning an enemy of the Kremlin with such signature agents is never meant to be about just the death of that enemy. It’s meant to send a message, which is itself a holdover from the bad old days of Communism. The KGB didn’t just destroy one life when it removed a troublemaker from the Soviet system; it then set about destroying the lives of his friends and relatives. If a dissident, for instance, was arrested, his spouse would lose her job, his children would be expelled from university, and/or his other family members would be banned from traveling abroad. Poison, deadly and effective, is perfectly efficient in that its victim doesn’t even die alone. The loved ones must share the horror of death by watching the poisoned expire slowly and painfully. Today, with the proliferation of social and digital media, the effects are even more pervasive and menacing: News of someone being rushed to the ICU with symptoms of acute stomach pain, pupil dilation, asphyxiation, or loss of consciousness sends shockwaves around the world. As with any act of terrorism, this one enlists everyone who so much as hears about it as ancillary psychological victims. Even President Trump, it was reported, was chilled by the

www.cbrne-terrorism-newsletter.com 56 HZS C2BRNE DIARY – October 2020 sight of lifeless Syrian children following the Assad regime’s use of chemical weapons in Douma in April 2018, an attack which led to a U.S. and UK military response against the facilities which manufactured and distributed those weapons. Poisoning is always a murky business, even when it’s meant to be transparent. By its very nature, use of an invisible murder weapon seen only by toxicologists in closed-off institutes and laboratories leads to wild conspiracy theories and “alternative” explanations. When somebody is shot to death in the street, with multiple gunshot wounds, it’s not really possible, except perhaps for the most febrile mind, to claim that the victim topped himself. But one can always insinuate suicide with poisoning, or even suggest that the victim hadn’t been poisoned at all but was in fact a lead actor in an elaborate act of political stagecraft designed to foster a diplomatic crisis or even war. When Litivineko was irradiated in London, a popular Russian newspaper claimed he’d succumbed to his own criminal business activity – namely that he’d tried to hawk radioactive materials on the black market and had accidentally killed himself with them. Many Russians found that theory credible. More than a decade hence, at the height of Salisbury’s containment in 2017, Russian state television was fond of insisting that Sergei and Yulia Skripal weren’t poisoned at all; rather, their entire ordeal was just a hoax orchestrated by British intelligence. Why? Because the Skripals, then under close British government guard, were never carted out before the cameras. To a paranoid and distrustful Russian audience, victim-blaming comes easily, and thus the target of state poisoning is attacked twice: first physically, then reputationally. In 2015, opposition politician Vladimir Kara-Murza, who has lobbied incessantly for the passage of anti-Kremlin U.S. sanctions, suddenly fell into a coma in Moscow and spent weeks unconscious in hospital. The Russian doctors first alleged his sudden illness was brought on by a dangerous combination of sedatives, nasal sprays and alcohol. Most Americans, with their long history of antidepressant use, would have seen right through such a feeble misdiagnosis. But to an ordinary Russian, it sounded plausible. Kara-Murza thus went from victim to irresponsible self-medicator and boozer. He was poisoned a second time, in 2017, while traveling in Russia. The following year, Pyotr Verzilov, the man behind the punk-activist group Pussy Riot, was also admitted to a hospital in Berlin after he left the Moscow district court, walked for two hours and then suddenly started losing his sight, speech and motor skills. Soon he had convulsions and fell into a semiconscious state in the ambulance. Pro-Kremlin media then came up with a theory that Verzilov had simply overdosed. He was declared a junkie, the easier not only to exonerate his assailants but to also dismiss the agitational life he’d led up to that point as one drug-fueled dissipation. It came hardly as a surprise, then, that when Navalny’s poisoning was announced, Margarita Simonyan, the editor-in-chief of RT, the Russian state propaganda channel, suggested on Twitter that he was only suffering from low blood sugar. The Russian Health Ministry put out a statement suggesting Navalny had had alcohol in his system, prompting a disinformation campaign on social media that he was drunk. Even Andrei Lugovoi, Litvinenko’s accused assassin turned parliamentarian, trolled the world. Russia’s opposition leader, he said, could only have been poisoned in Germany. Using Novichok or polonium means leaving a calling card. And yet, built right into this stark attribution of Kremlin responsibility are also the ingredients for conspiratorial denial. The West knows right away whodunit. Russians, meanwhile, are invited to consider that the culprit could be anyone and everyone except Putin.

Andrei Soldatov is a Russian investigative journalist, co-founder and editor of Agentura.ru, a watchdog of the Russian secret services’ activities. Irina Borogan is a Russian investigative journalist, co-founder and deputy editor of Agentura.ru, a watchdog of the Russian secret services’ activities.

The COVID-19 Vaccine. The Imposition of Compulsory Vaccination with a Biometric Health Passport? By Dr. Pascal Sacré Source: https://www.globalresearch.ca/the-covid-19-vaccine-the-imposition-of-compulsory-vaccination-with-a-biometric-health-passport/5720163

Oct 03 – The COVID-19 vaccine… Is this THE final goal of this crisis, to impose a compulsory vaccination on everyone, with a biometric health passport and without it, the impossibility to move, to buy, to eat? The near future will tell.

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With time, the accumulation of side effects, the testimonies of more and more doctors, vaccination has become a subject of controversy, often passionate, sometimes violent. This is not just a question of being for or against vaccination in general. It is about being vigilant in the face of enormous pressure from companies and governments to inject billions of healthy people with a hastily manufactured product, using immature technologies such as DNA manipulation, with as yet unknown side effects. The cure should not be worse than the disease. Given the fear, the terror in people’s minds, given the enthusiasm of certain leaders and given the power of the vaccine companies and manufacturers, will we, as ordinary citizens, be able to resist, keep our cool and prevent these people from playing with our health? Do you know what the marketing of vaccines brings to the pharmaceutical companies? References on the Statista website, figures for the year 2019 [1]: 1. GSK (GlaxoSmithKline): more than 8 billion euros. 2. Merck: €7.3 billion 3. Pfizer: €5.9 billion 4. Sanofi: €5.8 billion Billions, in a single year!

 Read the rest of this article at source’s URL.

New, more accurate coronavirus test proposed by Technion Source: https://www.jpost.com/health-science/new-more-accurate-coronavirus-test-proposed-by-technion-645461

Illustration of DNA molecules passing through a nanopore (photo credit: TECHNION SPOKESPERSON'S OFFICE)

Oct 12 – A new testing method for the coronavirus, proposed in a recent study published by the Technion's Faculty of Biomedical Engineering, headed by Professor Amit Meller, could pave the way to more accurate testing. A commercialization process is currently in the works in the hopes of making it readily available to the general public as soon as possible.

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In a regular PCR test a swab sample is taken from the patient, then RNA is extracted and sequenced into DNA form. That sequence is then amplified via a polymerase chain reaction (PCR). Once there are millions of copies, the presence of the virus can be detected. But this method has drawbacks which the researchers hope to redress. The challenge in requiring a large sample body to detect the virus is that the chance for error magnifies with the number of samples. Additionally, sometimes the viral RNA presence is quite low, which makes it harder to detect and easier to miss. The proposed method is overcoming these drawbacks. Instead of taking a massive sample size it proposes utilizing original technology from Professor Meller's lab group, in the form of nanofabricated holes, or "nanopores," to analyze individual molecules. That ensures a smaller sample size and greater accuracy. The molecules pass through an electric sensor, during which they give off a singular and unique electric signature. It would also strip away the other molecules, leaving the target ones intact, contributing to the greater precision of the tests. The proposition is to apply this technology to coronavirus tests, making the process quicker and more accurate. The end-goal is to make the test portable, lessening the work necessary in the lab. "We have shown that our technology preserves the level of genetic expression of the original RNA molecules throughout the entire process," said Professor Meller. "In this way, we obtain a more precise analysis method, which is essential."

Source:https://www.academia.edu/7100973/Understanding_public_responses_to_chemical_biological_radiological_and_nuclear_i ncidents_Driving_factors_emerging_themes_and_research_gaps

This 2014 paper discusses the management of public responses to incidents involving chemical, biological, radiologicaland nuclear materials (CBRN). Given the extraordinary technical and operational challenges of a response to aCBRN release including, but not limited to, hazard detection and identification, casualty decontamination andmulti-agency co-ordination, it is not surprising that public psychological and behavioural responses to such inci-dents have received limited attention by scholars and practitioners alike. As a result, a lack of understandingabout the role of the public in effective emergency response constitutes a major gap in research and practice. This limitation must be addressed as a CBRN release has the potential to have wide-reaching psychological andbehavioural impacts which, in turn, impact upon public morbidity and mortality rates. This paper addresses anumber of key issues: why public responses matter; how responses have been conceptualised by practitioners; what factors have been identified as influencing public responses to a CBRN release and similar extreme events, and what further analysis is needed in order to generate a better understanding of public responses to inform themanagement of public responses to a CBRN release.

EDITOR’S COMMENT: This is an article that you have to study instead of just reading it. The most important player in all CBRN incidents is the population and this player is almost always “forgotten” during the planning process. The most common but also the most important parameter lacking during the planning process is anthropocentricity – this means that we have to plan based on what people will actually do instead of the usual expectation of what they have to do and never be done! If you plan based on your own reaction then the plan composed will address the needs of the people in an efficient and realistic way.

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Alexey Navalny Has the Proof of His Poisoning By Masha Gessen Source: https://www.newyorker.com/culture/the-new-yorker-interview/alexey-navalny-has-the-proof-of-his-poisoning

Oct 18 – Alexey Navalny is the biggest thorn in Vladimir Putin’s side. A decade ago, Navalny, as a young lawyer in Moscow, started piecing together publicly available information to document corruption and abuse of power in the Russian government. At first, he used his blog to document inflated prices in government contracts, suggesting kickbacks; he moved on to documenting real-estate holdings, luxury cars, and cash reserves that government officials had registered in the names of relatives. Navalny’s one-man project grew into the Anti-Corruption Foundation, a multimedia production company with dozens of investigators whose tools have ranged from data mining to sending drones to film the estates of highly placed bureaucrats. One of Navalny’s biggest hits is a series of films about the then Prime Minister Dmitry Medvedev’s sneaker-collecting habits and estate, which included three helopads, a ski slope, cascading swimming pools, a hotel-style dormitory for staff, and a little lake house for ducks, which became an Internet meme. Russian authorities have been fighting to have the films removed from YouTube, where one of them has been viewed more than thirty-six million times. Navalny was one of the leaders of the mass protests against rigged elections that erupted in Russia in 2011 and 2012. Many of his fellow-members of the protest coördinating council are either living in exile, like the chess champion Garry Kasparov or the prisoners’- rights activist Olga Romanova, or dead, like the politician Boris Nemtsov. The Kremlin has tried to shut down Navalny and his organization through a series of court cases and arrests. But when Navalny was jailed in 2013, sentenced to five years on flagrantly trumped-up embezzlement charges, thousands of Muscovites protested and secured his release. When he was sentenced to house arrest, Navalny refused to comply, because the Russian penal code does not allow for such a punishment; after a few months, the authorities gave up, although his brother, Oleg, remained behind bars for years on spurious charges. Navalny’s activism and reach kept expanding—he even attempted to run for President—and for a few years he seemed invincible. (In a piece for this magazine in 2016, I wrote, “The strangest thing about Alexey Navalny is that he is walking around Moscow, still.”) But, on August 20th, Navalny fell ill when returning to Moscow from the Siberian city of Tomsk. He was in a coma for twenty-six days, most of them in a hospital in Berlin. Analysis performed by multiple European labs shows that he was poisoned with a previously unknown version of Novichok, a deadly Russian-developed chemical agent. Navalny regained his ability to speak, write, and make jokes within ten days of coming out of the coma, but he has continued to experience significant physical effects owing to the poisoning. He spoke with me, over Zoom, from an apartment in Berlin, on October 8th; through the screen, it was obvious that Navalny had lost a great deal of weight, but otherwise he looked and sounded as I’d always remembered him. Our conversation has been translated from Russian and condensed. How did you know what had happened to you? This is the hardest part. The moment I knew that I’d been poisoned was the moment I realized my life was ending. What I was experiencing up until then was a kind of incomprehension. We can understand a heart attack or a stroke, but we cannot understand the effects of cholinesterase inhibitors—evolution does not prepare us for this. You are in this strange state of losing focus, and the strangeness keeps growing. I’ve compared it to being touched by a Dementor in a Harry Potter novel—you feel that life is leaving you. Let’s say I touch my own hand with my finger. My brain can perceive that signal and then cancel it out. But Novichok makes it not get cancelled out, so it feels like I’m touching my own hand a million times a second, and every cell in my body goes berserk, and the brain understands that this is the end. Let’s go back a second. You have boarded a plane from Tomsk to Moscow. You’ve opened up your laptop and started watching “Rick and Morty,” as is your habit. And then— I started losing focus. Say, right now, I see you on the screen. I understand that Kira is here in the room. [Kira Yarmysh, who is Navalny’s spokeswoman, was present during our interview; she was also seated next to him on the Tomsk-Moscow flight.] I understand this, but I cannot see it and focus on it. I have the strength to point at the screen. I see the cat who has entered the frame. But I can’t grasp the concept of “cat,” and if someone asked me to point at the cat on screen, I’d have a very hard time. On the airplane, I went to the bathroom and I realized that I would not be able to leave the bathroom on my own, and this was when I knew I’d been poisoned. It was so difficult to open the door. I could see the door, I could understand everything, and I was plenty physically strong enough—I would have been able to do pushups, if only, at that moment, I had been able to grasp the concept of pushups. I guess if I’d had sudden heart pain or abdominal pain, I would have realized even faster that I was dying, because this physical experience would have been familiar to me. But this was worse than pain.

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I’m trying to understand what you are describing, using my own experience. Have you ever been sedated with opiates? Sure, I had my appendix removed. And last month, too, I had the experience of coming out of sedation. This was nothing like it. Some people have compared it to a panic attack. But I think I understand what a panic attack feels like: a sense of growing anxiety. Anxiety is a feeling you can ultimately comprehend. I came out of the bathroom. I could still stand upright. I saw my seat and realized I would probably never make it that far. I thought I should probably ask for help, but I also thought that, by this point, it would be useless. So, I informed the flight attendant that I was about to die, right there on their plane, and I lay down. On the floor. And then they tried to keep you awake, right? They were saying, “Sir, stay with us, please don’t lose consciousness. . . .” But I did. Did you have a sense of the passage of time? I just felt indifference. It was clear that this was the end. I imagine that a person, when they are dying, thinks about important things, like, This is what I haven’t completed, or, What will happen to my children, or, What will my wife say? But I was finding it so difficult to think at all. So those awful screams that someone recorded— I don’t remember those. I might have been hallucinating. And the next thing you remember was nearly a month later? For a while, I was convinced that I was in the hospital and I’d lost my legs and was waiting for new legs to be made for me. And my wife, Yulia, and Leonid Volkov [Navalny’s closest associate in his political work] and the doctors kept telling me that I’d been in an accident and they’d make me new legs, and I shouldn’t worry. Obviously, there were no such conversations. Gradually, I started making contact with reality, in which there was Yulia and I waited for her to come every day and adjust my pillow. But I was still missing legs. And I had these awful hallucinations that really got to me, like I’m in a jail cell and the cops won’t let me sleep, and they keep asking me to recite the rules for being in jail, interspersed with lyrics by the [Russian rap group] Krovostok. Yulia and Volkov told me that there was a prolonged period when they would sit me up, and I would just stare, and they couldn’t tell whether I recognized them. As I recall, I was having mind-blowing conversations with them in my imagination. Yulia hung up a small flip chart and marked every day I spent in the hospital with a heart in magic marker. I reacted to that flip chart and looked at it, but I don’t remember any of that. I do remember the horrible feeling when you can’t speak or write. What do you mean? The doctor says, “Do you understand that you are Alexey Navalny?” I do. “Do you remember your age?” I do. “Do you understand that you are currently in Berlin?” I knew this, though I wasn’t particularly interested in why I was here. “Can you say a word?” I know I have a tongue, and I have lots of words floating around in my head. But that part of the brain where a word takes shape and you pronounce it—that wasn’t processing. I couldn’t say a word. This was torture. I probably looked like the cat in that scene in “Shrek,” with intelligent eyes but speechless. I can’t say anything and I can’t even get angry, because I can’t remember how emotions work, either. But this didn’t last long—about a week. I don’t remember this, either, but Yulia and Volkov have told me that when I did start talking, I addressed everyone in English. Then I discovered that I couldn’t write. They’d give me a piece of paper, and I realized that I couldn’t place letters in a line in the correct order. Say, “Masha.” I remember what the word looks like. I know that the first letter is “M,” followed by an “A.” I start writing— the first letter that comes out is “S.” Then I place the second letter below it—I’m writing in a column. I can see that this is totally wrong. I cross it out. I start over, and the same thing happens. This scared me, so I kept practicing, and I didn’t calm down until I was sure that I could put letters in a line and that I could write out the word I’m asked to write. I don’t remember being unable to read—they would sometimes turn on the TV to keep me entertained, and I understood the subtitles. What was the first word you tried to write? I wanted to ask for water, but I couldn’t come up with the word. I asked my doctor later—after all, many people have been in a coma— did they have the same experiences? He said that, first of all, my coma was unusually long. Also, it was overlaid with the poisoning by Novichok, and there is nothing to compare that to. They say the same thing about my rehabilitation: they can’t tell me anything, because, as far as we know, there are barely any known cases of people who survived Novichok. [They include the former Russian double agent Sergei Skripal and his daughter Yulia, who were poisoned in England two years ago.] Plus, I was poisoned with a different kind of Novichok. Even the Organization for the Prohibition of Chemical Weapons classifies its reports, because no one wants to publish the formula. This is a thing from hell. Chemical weapons are rightly banned. Conventional weapons can be used to kill people, but also to protect them; these substances are intended solely for making people die a painful death.

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How would you describe your condition now? I’m like a little old man. I was in the I.C.U. for twenty-six days, so I figured I’d be back to normal after twenty-six more. It hasn’t been that long yet, but I notice strange things. For example, I’ve lost all flexibility. I’m like the Tin Man from “The Wizard of Oz.” I’m doing a lot of physical therapy. My first physical-therapy sessions involved two glasses of water. I had to use a tablespoon to scoop up water from one glass and pour it into the other. It was so fucking difficult. It was unbearable torment. The first time they threw a ball at me, there was no way I could have caught it. I couldn’t walk across a room. My hands were shaking. In my mind, I felt like I did before, but then I’d try to get into a car with my hands and feet shaking. I can take long walks, up to three hours. I’m sitting as I talk to you, and it’s all right. It’s hard to concentrate for a long time, and it can get tiring to keep track of the questions and think about my answers. But that’s all right. Now, pulling a T-shirt off—that’s truly difficult. Strength is coming back faster than coördination and balance. I can now use the phone again, despite shaky hands. By the time you came to, all the information was there, right? The labs—one in Sweden and one in France—had already determined that it was Novichok. They’d done the testing while I was still in a coma, with Yulia’s permission. The only thing that’s happened since is the Russian authorities making crazy claims about me being a C.I.A. agent and all that. Who was the person who gave you the information that you had been poisoned with Novichok? Yulia. I had to be told multiple times; it took me a while to grasp. It still sounds bizarre. But the lab results—you can’t argue with those. Of course, this completely changes our understanding of how the Russian authorities work. We used to think we knew that Putin divides people up into different categories. There are the secret agents and former secret agents, and they can kill one another, poison one another, spray one another with polonium or Novichok, because they have their own rules. Then there are the politicians and other civilians. The instruments they use against politicians are arrests, fabricated criminal charges, defamation campaigns. But to kill so blatantly, using Novichok—that sends a very strong message. A mysterious death, especially of a relatively young person, scares people. Their plan was that no medical examiner, not even the most conscientious one, would be able to find traces of Novichok. There are, maybe, only seventeen laboratories in the world that can find it. You need a super-powerful mass spectrometer. They made sure to wait forty-eight hours [before Navalny was allowed to be evacuated to Germany], and after that, they were convinced that no one would be able to find anything on me. It would have been recorded as a suspicious death. That is a stunningly effective intimidation method: “He didn’t know his place, he exposed corrupt officials, he called Putin a thief—and what do you know, he is dead at forty-four. Could be his heart gave out. Could be something else.” You say that you thought they reserved poison for secret agents, but we know that Pyotr Verzilov, a Pussy Riot activist, was poisoned, and so was the journalist and activist Vladimir Kara-Murza, who was poisoned twice— That’s true. It was obvious to me that they were both poisoned. They were both very healthy, and Kara-Murza, like me, turned into an old man who had to use a cane. But still—and this is the tricky thing—even though I knew both of them, and I had no doubt that they were poisoned, there is always this little voice, this bit of doubt. Like, really, did they poison them? But why didn’t they die? Maybe they really did take too much medicine? My wife went through the same thing. On the one hand, it was obvious that I’d been poisoned. On the other hand, there were all these doctors, at the hospital in Omsk, wearing their white coats, saying, “Of course, he wasn’t poisoned, of course, it’s a case of pancreatitis.” It’s hard to argue with that. They are doctors! And we are not. And Yulia and Volkov both told me that even as they were making arrangements to have me airlifted to Germany, they were thinking, “What if it is pancreatitis and tomorrow he comes to in Germany, furious?” When Kira was with me in the ambulance, the medics told her I had clearly O.D.’d. “Tomorrow he’ll be walking around and talking,” they said. Novichok was apparently on something I touched. They say that if you inhale it, you die very quickly. If you ingest it with food, you are dead within an hour. If you touch it, it takes about three hours. But no one knows where it was. No one knows how this new version of Novichok acts. This scares people very effectively. You can decide not to fear being arrested or being shot. But when you are just walking around, and the next thing you know, your lifeless body is lying in the street, and a normal pathologist will never find anything? My case is unusual because, thanks to a series of happy accidents—the pilot who decided to make an emergency landing, the ambulance staff who acted on the assumption I’d overdosed and tried to revive me, and the fact that some traces of Novichok remained even after forty-eight hours—they actually found Novichok. We got evidence. And the thing about Novichok is you can’t just go and use it. If I give you some Novichok and tell you to go kill someone with it, you are going to kill yourself and the people around you and probably not the person you are targeting. You have to be trained to use it. This definitively changes our picture of what happens inside the Kremlin, and now we have proof. Every interviewer used to ask you, “Why haven’t you been killed yet?” So, you have this understanding that you should have been killed by now, and you have people you

www.cbrne-terrorism-newsletter.com 63 HZS C2BRNE DIARY – October 2020 know who nearly died from being poisoned, and yet somehow your mind tells you, This won’t happen to me, because— why? Because you think rationally. There are a million ways to isolate someone or kill them, but this is like some trashy thriller. I find myself living inside of a James Bond movie. If you told me that they planned to kill me using Novichok and administer it in such a way that I would die on an airplane, I would say that’s a crazy plan, because there are so many ways for it to fail. It’s like if someone asked me if I believe that I’m at risk for being beheaded with a lightsabre. I’d say no, even if I saw that someone I know is missing an arm and it looks to have been lasered off. Did you have any personal safety protocols? I know that when Garry Kasparov was still living in Russia, he never drank water except from his own supply, he didn’t eat in restaurants— I remember the first time he was in jail [sentenced to five days in 2007 for an unsanctioned protest] he didn’t eat a thing because he was afraid that they’d poison him. And we all laughed at him! We thought he was paranoid. He is the only person I know who took any security measures. But what can you do? The poison wasn’t in my food. A person can leave their apartment, open the car door, and be a goner—the door handle can serve as the contact surface. You can eat only the food you cooked yourself and drink only water you poured yourself, and still there is nothing that can keep you safe from surface contact. Let’s summarize what preceded this poisoning, just to make sure the reader understands how you were being silenced by a thousand cuts. Give me the highlights, perhaps starting with the first case against you and ending with all your bank accounts being frozen. Back in 2009 and 2010, my anti-corruption activities started getting people’s attention. I was filing court claims against giants like [the state-backed gas monopoly] Gazprom, and I even won a couple of times—the courts ordered them to release certain reports. In 2010, I was a World Fellow at Yale, and just when I was supposed to come back, there was a news item that I could be facing criminal charges. This was meant to keep me from coming back to Russia. I returned anyway, and they just started escalating, first by planting news stories about me, then there was the first trumped-up case against me [in 2011]. They made a mistake that I think they regret, when they let me run for mayor of Moscow. I would have won in the runoff if they hadn’t rigged the vote. So this was when they got scared enough to conjure another criminal prosecution against me, and that’s when they arrested my brother, taking him hostage. In the last two years, the pressure has really ramped up. Our offices have been raided by law enforcement repeatedly. There have been a number of criminal prosecutions. They tried to crush our nationwide structure, which they perceive as the biggest threat to their power. We are the victims of our own success. They saw that the organization can’t be beaten down, so they decided to seek a final solution. They imagined that if they removed me from the organization, the organization would break. They were wrong. The last two years is when you’ve promoted a strategy you call “intelligent voting.” Can you explain it? It’s tactical voting. It’s when we convince voters to back the No. 2 candidate—we may not like him, but he has a chance to knock out the representative of the ruling party. Usually all the candidates outside of United Russia get more than fifty per cent of the vote taken together, but it’s dispersed, so United Russia always wins. We used to think we’d never convince liberal voters to back a Communist, often even a Stalinist, or vice versa—convince Communists to back a liberal candidate—but we’ve succeeded in doing that to various extents in different places. Of course, Putin and the rest of them see this as a major threat. For Putin, United Russia is a foundational political structure. Yes, he controls the courts and dominates all the other parties, but in any autocratic regime, the ruling party is the key structure. This was true in the U.S.S.R. and East Germany, and is now true in Belarus, in Russia, and in Syria. There is always a ruling political party, and its ability to reliably take elections is what gives the regime its stability. Where has your approach worked? In Tomsk, United Russia no longer has a majority in the city legislature, for the first time in twenty years. In Moscow, we didn’t manage to do that, but we got a bunch of very active people into the city legislature. Same in Novosibirsk. All these years you’ve been fighting corruption. Do you think this is Putin’s most important quality—that he is corrupt? He is obsessed with power as a way of amassing wealth. He is obsessed with money. He is personally involved in apportioning money—he decides how much he gets, how much each of his people get. Gradually, of course, power became more important. Now he is, without a doubt, the most powerful man on the planet, because nothing keeps him in check. Sure, the U.S. President leads a stronger country, but he is constrained by the courts, by Congress, by the media, by the opposing party. Putin leads a country that’s not particularly strong, but there are no constraints on him at all. He could be using this power in different ways, but to him it’s just a giant money pump. He wants more: more palaces, more money, more billions. So I have been fighting corruption, because corruption is the political foundation of this regime. So, you think that “Putin is corrupt” is a more important or precise statement than “Putin is a murderer”?

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Yes. Because he murders in order to be able to perpetuate the corruption. He is different from someone like Lukashenka, for example—Lukashenka is very corrupt as well, but he doesn’t have this bottomless thirst for goatskin sofas, gold handguns, and giant palaces. What are the palaces for? Putin can’t live in them while he is President, and he won’t be able to live with them if he ever stops being President, because if he ever loses power, he’ll end up in prison or in exile. Why do people collect stamps or baseball cards? They die, and their descendants sell them off. Why do you accumulate as much gold as you can in a computer game? That’s how people work—they always want more. And he wants to take all the money in part so that other people don’t have it and can’t influence him. I understand you are going back to Russia after you recover? Of course, I’m going back. If I don’t, that will be the ideal outcome for them. They’d love to have me as just another political émigré. You have given one interview so far to a Russian journalist, the very popular YouTube talk show host Yury Dud. I found it hard to watch, because he says you are wrong to think that you were poisoned and accuses you of having delusions of grandeur. And this is a journalist who supports you politically! Yet he refuses to believe that it’s all so simple, so crude, and so cruel. What was that like for you? I don’t mind. The news sounds so crazy that it’s hard to believe. I can afford to be O.K. with it, because the facts speak for themselves. It’s not me people are arguing with but chemistry and independent labs. Anyway, my entire political life consists of having arguments with people who believe in nothing or believe in conspiracies, or who are just dumb. So having to argue my case is nothing new. I like doing it. I’m not going to be able to persuade everyone, but I will persuade some people, simply because I stand on the facts and the truth.

Masha Gessen, a staff writer at The New Yorker, is the author of eleven books, including “Surviving Autocracy” and “The Future Is History: How Totalitarianism Reclaimed Russia,” which won the National Book Award in 2017. Jerusalem Post Israel News IDF not prepared for chemical weapons attack Source: https://www.jpost.com/israel-news/special-report-idf-not-ready-for-chemical-weapons-attack-646226

The IDF Home Front Command drills gas a chemical weapons attack against Israel in 2013 (photo credit: REUTERS).

Oct 20 – The IDF is not ready for the dangers posed by a chemical-weapons attack, State Comptroller Matanyahu Englman said in a report Monday. Past State Comptroller’s Reports have come to the same conclusion, and the issue has jumped into the headlines many times, including as recently as 2014 and 2016. Highlighting why the threat needs to be taken seriously, Englman wrote: “Use of chemical weapons in war has been a known threat for many years. During the civil war in Syria, starting from 2011, the Syrian regime used chemical weapons against the rebels and against civilians.” “Other militaries are struggling with this threat, including the US military, which views it as a significant and complex challenge,” the report said. The report covers the period of June 2019 until February 2020 and lists a number of deficiencies.

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Land forces and special units that deal with weapons of mass destruction (WMD) are poorly prepared, the report said. Training for units responsible for border security to inspect for or handle potential chemical items is not up to the necessary standards, it said. Other relevant units also do not train enough for chemical-weapons scenarios, the report said. It did compliment the IDF’s general improvement in tailoring training to mission goals. Englman recommended that the commander of land forces lead a campaign to improve combat units’ readiness for chemical warfare. In September 2014, the IDF deputy chief of staff made Home Front Command responsible for WMD gear. But in practice, the relevant equipment remained spread out in a disorganized manner throughout the infantry forces, Home Front Command and IDF air and space forces. Current IDF Deputy Chief of Staff Maj.-Gen. Eyal Zamir should institute a process to ensure that the flagged deficiencies are addressed, the report said. Responding in May, Zamir said the military would reevaluate its readiness for the chemical-weapons issue, but only within the context of the broader “Momentum” financial plan. It would only be funded to the extent that funding was available, given the IDF’s many priorities, he added. Parts of the report criticized the office of the IDF chief engineer, the Technology and Logistics Branch and the Medical Corps. Englman suggested that the IDF chief engineer work on closing the gaps in terms of necessary equipment for protection from the chemical-weapons threat. In addition, since 2017, soldiers who need glasses to see have not been given special chemical-weapons goggles. This practically makes such soldiers useless in the event of a chemical-weapons attack, the comptroller said. In May, the IDF said it would study the issue. It appeared that the IDF would not have tackled the issue at all without the comptroller raising it, and that even once the issue was raised, it may take years before it is concretely addressed. The IDF said it hoped to start formulating a solution next summer. Aspects of the full report remain classified due to national security reasons, but significant sections of it have been made public. The IDF responded by acknowledging the report’s contribution to efforts to maintain readiness regarding the WMD threat. It disagreed with some conclusions and said other issues were already in the process of being dealt with. The IDF said it has clear directives at its different levels for dealing with WMDs, despite the report’s criticism that there are deficiencies in that area. A 2014 Comptroller’s Report on the issue made virtually identical criticisms, signaling that the lack of addressing the issue over the last six years shows that the issue is not a priority for the IDF. In 2013, then-comptroller Yosef Shapira and the High Court of Justice criticized the state for a shortage and other deficiencies in distribution of gas masks to the public. Part of the debate dates back to Syria’s elimination of large aspects of its chemical-weapons stock in 2013. This led to many officials claiming that continued investment in gear and other chemical-weapons defense measures was a waste of funds and should be redirected elsewhere. However, even after the Assad regime was supposed to have eliminated its entire chemical-weapons stockpile, it continued to use chemical weapons as the Syrian civil war dragged on for years. In 2016, concerns spiked that Iran and the Assad regime were trying to smuggle chemical weapons to Hezbollah for use against Israel. As far as Israel is concerned, Israeli intelligence has in the past said the chemical weapons used by Assad in Syria are primarily chlorine and not more dangerous chemical weapons such as sarin, VX and sulfur mustard. Until ISIS was routed in 2017, the US had said ISIS was using a small volume of poorly weaponized mustard gas. Against the backdrop of the IDF being unprepared for a chemical-weapons attack, the government halted its program to distribute gas masks to the public years ago. Besides a reduced volume of Syrian chemical weapons, some Israeli national security officials have concluded that the destruction the IDF could cause in Syria is so great that this threat is a sufficient deterrent.

EDITOR’S COMMENT: A bit surprised by what the article is referring to although I was aware about the population masks issue. The last sentence might be considered realistic but the “destruction” mentioned [nuclear?] will happen AFTER one or (preferably) more chemical attacks (because the risk is ridiculous for just a single incident) against densily populated areas; so, what is the point?

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Justice Initiative and Syrian Archive Expose New Information on Syria’s Chemical Weapons Program Source: https://www.justiceinitiative.org/newsroom/justice-initiative-and-syrian-archive-expose-new-information-on-syrias-chemical- weapons-program

Oct 19 – After two years of investigations, the Open Society Justice Initiative and the human rights group Syrian Archive have compiled the most comprehensive investigative report to date on Syria’s Scientific Studies and Research Centre (SSRC), the entity at the heart of Syria’s chemical weapons program. The groups submitted the report to the Organisation for the Prohibition of Chemical Weapons' (OPCW) Investigation and Identification Team, the UN investigative body—the Independent Impartial and Independent Mechanism (IIIM)—mandated to examine war crimes in Syria, France’s war crimes prosecutor, the war crimes unit of the office of Germany’s public prosecutor, and the U.S. Department of Justice on Monday. The report contains new information on how the Syrian government orchestrated attacks using sarin, a banned nerve agent whose use is considered a war crime. In addition, it includes information obtained from government defectors that sheds new light on Syria’s attempt to hide chemical weapons-related materials from the OPCW by transferring them from SSRC facilities to a Syrian army facility in 2013. The report also provides investigative leads regarding locations where Syria developed and produced the chemical munitions used in the deadly 2017 attacks on Ltamenah. In July, the OPCW gave the Syrian government a 90-day deadline to declare the facilities where the chemical weapons, including precursors, munitions, and devices, used in the 2017 Ltamenah attacks were developed, produced, stockpiled, and operationally stored for delivery. It also requested that Syria declare all chemical weapons currently in its possession, as well as chemical weapons production facilities and other related facilities. On October 14, the OPCW’s Director General

www.cbrne-terrorism-newsletter.com 67 HZS C2BRNE DIARY – October 2020 reported that Syria had not complied with these requests and with its obligations under the Chemical Weapons Convention. "Our research shows that Syria maintains a robust chemical weapons program,” said Steve Kostas, a senior legal officer with the Justice Initiative. “OPCW member states must insist on accountability for Syria’s continued non-compliance with the Chemical Weapons Convention, and they should call for a strengthening of efforts to hold perpetrators criminally responsible.” “All perpetrators of chemical weapons attacks in Syria should eventually face criminal prosecution,” added Hadi Al Khatib, founder of Syrian Archive. “Whether it be though the legal principle of universal jurisdiction, an international tribunal, or another mechanism, war criminals must be held accountable.” More than 200 chemical weapons attacks have taken place over the course of the Syrian civil war, most of which occurred after the Syrian government’s notorious 2013 sarin bomb attacks on opposition areas of the Damascus suburbs, which killed an estimated 1,300 people. Over the course of the Syrian war, chemical weapons have killed thousands of civilians, including many children, and many more have suffered long-term disabilities and trauma. During a meeting that will take place from November 30 to December 4, the 193 members of the OPCW Conference of the States Parties will debate consequences for Syria’s non-compliance with the Chemical Weapons Convention. The Conference of the States Parties has the power to recommend collective measures that states can take against the Syrian government and to refer the matter to the UN General Assembly.

 Read the summary of the report here.

New Reporting on Russian Novichok Program A group of investigative journalists have published a major set of stories on Russia's Novichok program and the organizations and individuals involved in its use in the Skripal case.

❖ Bellingcat, "Russia’s Clandestine Chemical Weapons Programme and the GRU’s Unit 29155," https://www.bellingcat.com/news/uk-and-europe/2020/10/23/russias-clandestine-chemical-weapons-programme-and- the-grus-unit-21955/ ❖ RFE/RL, "Poisons, Patents, Phone Logs: Records Reveal Russian Scientists’ Ties To Military Intelligence," https://www.rferl.org/a/exclusive-poisons-patents-phone-logs-records-reveal-russian-scientists-ties-to-military- intelligence/30908850.html ❖ The Insider, "Say my name. Who and how produces "Novichok" for special services in Russia," https://theins.ru/politika/236238 ❖ Der Spiegel, "The trail leads to Saint Petersburg," https://www.spiegel.de/politik/ausland/sergej-skripal-attentat-die-spur-zum- labor-in-st-petersburg-a-316d00cd-b942-4e38-a593-17b30cff3a0a

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sting, Testing

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Simple blood test predicts patients most likely to die from COVID-19 Source: https://newatlas.com/health-wellbeing/coronavirus-blood-test-predicts-mortality-disease-severity-rdw/

Sep 23 – One of the big challenges’ healthcare workers are facing in this global pandemic is identifying those COVID-19 patients most at risk of severe illness and death. COVID-19 certainly is more dangerous, on average, in the elderly or those with pre-existing health problems, but that doesn’t preclude a 96-year-old from presenting with no symptoms, or a healthy 21-year-old losing her life. A team of researchers from Massachusetts General Hospital have been trawling through hospital admission data to find some way to help doctors better assess those patients most at risk of suffering the worst effects of the disease. The researchers analyzed blood samples from 1,641 patients admitted to Boston hospitals with COVID-19 earlier this year. The plan was to closely study the samples to identify any particular molecular patterns that could predict disease severity. Before looking at more complicated blood-based biomarkers the researchers first looked at biomarkers gathered in the most routine blood tests. "We were surprised to find that one standard test that quantifies the variation in size of red blood cells – called red cell distribution width, or RDW – was highly correlated with patient mortality, and the correlation persisted when controlling for other identified risk factors like patient age, some other lab tests, and some pre-existing illnesses," says co-author on the new study, Jonathan Carlson. RDW is a very common metric gathered in most standard blood count tests. The new study found patients displaying an elevated RDW at time of admission were 2.7 times more likely to die from COVID-19. Elevated RDW was also more significantly associated with mortality in younger COVID-19 patients. The study also notes that patients whose RDW was seen to increase during hospitalization were more likely to suffer worse outcomes from the disease. The researchers suggest this indicates RDW may be a useful biomarker to track the progress of a patient while admitted in hospital. RDW has been previously determined to be an effective non-specific biomarker of illness, and the researchers do note it is unlikely there is a direct causal relationship at play. But, what is important here is the routine nature of RDW measurements gathered in common blood testing. A number of similar studies have been published over the past few months exploring blood-based biomarkers to identify patients most as risk of death or severe illness from COVID-19. Many researchers have homed in on particular blood biomarker patterns that can be associated with the worst outcomes, however, not many of those blood measurements are as simple and routine to collect as RDW measurements. The finding needs further validation in broader cohorts of patients, but if confirmed, this simple laboratory test may be a useful way to detect those COVID-19 patients most in need of clinical care.

 The new research was published in the journal JAMA Network Open.

Coronavirus Vaccines Still Aren't Being Tested in Kids, And Experts Are Concerned Source: https://www.sciencealert.com/potential-covid-19-vaccines-still-aren-t-being-tested-in-children

Sep 24 – Progress on coronavirus vaccines has moved remarkably fast since the novel virus was first identified and sequenced in January. The leading experimental shots are now in the final stage of clinical trials, with results expected as soon as next month. But that progress has focused on crafting and testing a vaccine for adults. Children have yet to be involved in any coronavirus vaccine trials, leaving some experts to worry that children could be left without a viable COVID-19 vaccine for some period of time. Drugmakers usually test a vaccine in children before seeking approval to give the shots to kids. Business Insider asked the leading drugmakers - Pfizer, Moderna, AstraZeneca, and Johnson & Johnson - for their plans on testing their coronavirus vaccines in children. All four companies told us that they plan to do so, but none provided an estimate on when a shot could be available for children. Right now, all four companies are in the final stage of testing their experimental shots in adults. Moderna told Business Insider it plans to start a pediatric trial for its shot before year's end, pending approval from regulators. "Subject to regulatory approval, our intent is to start by the end of this year," said Ray Jordan, Moderna's chief corporate affairs officer. Jordan added that Moderna doesn't have anything more to share publicly on the timing, protocols, or funding for pediatric studies "because these regulatory discussions are still underway."

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Johnson & Johnson chief scientific officer Paul Stoffels said J&J is committed to eventually running pediatric trials. Opening studies for children "will come later in the year" after safety is established in adults, Stoffels said on a September 22 call with reporters. The other drug companies didn't say when they'd start their studies in kids.

Drugmakers give general commitment with few specifics to studying vaccines in children The lack of information on how and when drugmakers plan to test their coronavirus shots in kids has caused concern among some pediatricians and vaccine experts. "Right now I'm pretty worried that we won't have a vaccine available for kids by the start of next school year," Dr. Evan Anderson, a paediatrician at Children's Healthcare of Atlanta, told The New York Times' Carl Zimmer. BI asked leading drugmakers if they expect to receive government funding to run these trials. None directly answered the question, although an AstraZeneca spokesperson said its deal with the US government includes pediatric studies. The US government's coronavirus vaccine initiative has committed roughly $US10 billion to drug companies to fund trials, produce doses and pre-purchase a supply of several experimental vaccines. Operation Warp Speed leaders have not laid out, or even mentioned, a plan for vaccinating children over the past few months. A couple factors explain why children are being left behind in this research. In general, researchers start testing an experimental shot on the least vulnerable population - young and healthy adults - and then start expanding into more vulnerable groups as clinical data accumulates that shows it's worth testing the shot. That can include testing in older people and people with other illnesses. A recent change to Pfizer's coronavirus vaccine study shows how this works. The pharmaceutical giant recently boosted its enrolment target from 30,000 volunteers to 44,000 people, and it also said it now wants to enrol 16- and 17-year-olds, as well as people with hepatitis C, hepatitis B, and HIV. "To address the burden of disease in pediatric populations younger than 16, we are working actively with regulators on a potential pediatric study plan," a Pfizer spokesperson said. While children may not typically suffer the severe outcomes of COVID-19 seen in the elderly, finding a vaccine for kids is still an important element of countering this pandemic. "Although children infected with SARS-CoV-2 are more likely to be asymptomatic, symptomatic and sometimes serious illness occurs," Pfizer's spokesperon said. "In addition, children may prove important in spreading SARS-CoV-2 to the community." Specifically, for COVID-19, fatality and hospitalisation rates are far worse for older people. Childhood illnesses from the novel coronavirus have been exceedingly rare, like a handful of reported cases of Kawasaki disease. Drug companies said their priority in responding to the pandemic was protecting populations most susceptible to severe outcomes first. An AstraZeneca spokesperson said the company would start enrolling children "once sufficient data are gathered in adults, indicating that AZD1222 has the potential to be safe and protective in children."

J&J’s One-Shot COVID-19 Vaccine Advances to Phase 3 Testing Source: https://www.medscape.com/viewarticle/937932

Sep 23 – Johnson & Johnson (J&J) on Wednesday said it advanced into phase 3 testing of its COVID-19 vaccine candidate, which uses the same technology as an Ebola vaccine already approved by European regulators. The National Institute of Allergy and Infectious Diseases (NIAID), which is aiding Johnson & Johnson with development, described this in a news release as the fourth phase 3 clinical trial of evaluating an investigational vaccine for coronavirus disease. This NIAID tally tracks products likely to be presented soon for US Food and Drug Administration (FDA) approval. (The World Health Organization's COVID vaccine tracker lists nine candidates as having reached this stage, including products developed in Russia and China.) As many as 60,000 volunteers will be enrolled in the trial, with about 215 clinical research sites expected to participate, NIAID said. The vaccine will be tested in the United States and abroad. The start of this test, known as the ENSEMBLE trial, follows positive results from a Phase 1/2a clinical study, which involved a single vaccination. The results of this study have been submitted to medRxiv and are set to be published online imminently. New Brunswick, New Jersey-based J&J said it intends to offer the vaccine on "a not-for-profit basis for emergency pandemic use." If testing proceeds well, J&J might seek an emergency

www.cbrne-terrorism-newsletter.com 71 HZS C2BRNE DIARY – October 2020 use clearance for the vaccine, which could possibly allow the first batches to be made available in early 2021. J&J's vaccine is unusual in that it will be tested based on a single dose, while other advanced candidates have been tested in two- dose regimens. J&J on Wednesday also released the study protocol for its phase 3 test. The developers of the other late-stage COVID vaccine candidates also have done this, as reported by Medscape Medical News. Because of the great interest in the COVID vaccine, the American Medical Association had last month asked the FDA to keep physicians informed of their COVID-19 vaccine review process.

Trials and Tribulations One of these experimental COVID vaccines already has had a setback in phase 3 testing, which is a fairly routine occurrence in drug development. But with a pandemic still causing deaths and disrupting lives around the world, there has been intense interest in each step of the effort to develop a COVID vaccine. AstraZeneca PLC earlier this month announced a temporary cessation of all their coronavirus vaccine trials to investigate an "unexplained illness" that arose in a participant, as reported by Medscape Medical News. On September 12, AstraZeneca announced that clinical trials for the AZD1222, which it developed with Oxford University, had resumed in the United Kingdom. On Wednesday, CNBC said Health and Human Services Secretary Alex Azar told the news station that AstraZeneca's late-stage coronavirus vaccine trial in the US remains on hold until safety concerns are resolved, a critical issue with all the fast-track COVID vaccines now being tested. "Look at the AstraZeneca program, phase 3 clinical trial, a lot of hope. [A] single serious adverse event report in the United Kingdom, global shutdown, and [a] hold of the clinical trials," Azar told CNBC. The New York Times has reported on concerns stemming from serious neurologic illnesses in two participants, both women, who received AstraZeneca's experimental vaccine in Britain. The Senate Health, Education, Labor and Pensions Committee on Wednesday separately held a hearing with the leaders of the FDA and the Centers of Disease Control and Prevention, allowing an airing of lawmakers' concerns about a potential rush to approve a COVID vaccine.

Details of J&J Trial The J&J trial is designed primarily to determine if the investigational vaccine can prevent moderate to severe COVID-19 after a single dose. It also is designed to examine whether the vaccine can prevent COVID-19 requiring medical intervention and if the vaccine can prevent milder cases of COVID-19 and asymptomatic SARS-CoV-2 infection, NIAID said. Principal investigators for the phase 3 trial of the J & J vaccine are Paul A. Goepfert, MD, director of the Alabama Vaccine Research Clinic at the University of Alabama in Birmingham; Beatriz Grinsztejn, MD, PhD, director of the Laboratory of Clinical Research on HIV/AIDS at the Evandro Chagas National Institute of Infectious Diseases-Oswaldo Cruz Foundation in Rio de Janeiro, Brazil; and Glenda E. Gray, MBBCh, president and chief executive officer of the South African Medical Research Council and co-principal investigator of the HIV Vaccine Trials Network (HVTN).

Many Metrics to Measure COVID-19 – Which Are Best? Source: https://www.medscape.com/viewarticle/937930

Sep 23 – You've seen the debates, on television or on social media, or even in your own conversations. They go something like this: "We should reopen (schools, cities, states, countries) because the number of daily cases is down!" one person says. "No, no, you have to look at the death rate! That's a lagging indicator and is still going up!" says another person. "And our hospitalization rate is still way too high!" a third person chimes in. In this pandemic, there are many different metrics used to measure the situation. Each has its own usefulness and its own limits. The metrics used to track the coronavirus pandemic typically include daily cases, hospitalizations, and deaths. Analyzing these metrics separately can show how much community spread there is or whether hospital capacity is being reached. "Metrics serve different purposes — it depends on the purpose for using the data," says Amesh Adalja, MD, a senior scholar at the Johns Hopkins University Center for Health Security in Baltimore. The University of Washington's Institute for Health Metrics and Evaluation (IHME) makes forecasts based on what is known about a disease and how people's actions may affect that. The IHME's latest COVID-19 forecasts say the U.S. will reach nearly 317,000 deaths by Dec. 1, at the current rate of mask-wearing, which dropped to slightly below 50% nationally last

www.cbrne-terrorism-newsletter.com 72 HZS C2BRNE DIARY – October 2020 week. But increasing mask wearing in public to 95% could save more than 67,000 lives, says Ali Mokdad, PhD, a professor of health metrics sciences at the IHME. "Forecasts are not static but can change depending on public behavior," says Mokdad, who's also chief strategy officer for population health at the University of Washington. When people learn that new cases are rising, they start wearing masks and using social distancing again; and when they realize new cases are declining, they tend to drop their guard, he says. New cases surged when governors lifted lockdowns in several states in the Southeast and Southwest in the spring. At least 34 states have now mandated statewide mask wearing. To create the forecast, the IHME uses real-time infection data from Johns Hopkins University's Coronavirus Resource Center to model disease transmission and project how many Americans will die. The researchers then estimate how many Americans are wearing masks or using social distancing, which can change the final model.

Measuring COVID-19 Transmission Researchers estimate the rate of infection in a population based on the "R0," or reproduction number. R0 is the average number of people who will catch the disease from a single infected person, in a population that's never seen the disease before. So, if R0 is 3, that means one case will create an average of three new cases. When that transmission rate of infection occurs at a specific time, it's called an "effective R," or "Rt." When the R0 is less than 1, that means the epidemic is under control; and when it's higher than 1, it is still spreading. When the IHME analyzed the combined data on cases, hospitalizations, and deaths for the week ending Aug. 27, it found transmission increasing in a cluster of states in the Upper Mississippi Basin, including Iowa, Indiana, Missouri, Kentucky, and Tennessee. The "effective R is also over 1 in Oklahoma. In all other states the effective R is less than 1." For the CDC, COVID-19 cases come from positive tests results. Websites that track COVID-19 often report these as confirmed cases. But just looking at raw case numbers won't tell you how much of the population is infected, says Adalja, the Johns Hopkins senior scholar. "You have to adjust or control for that population size by using one case per 100,000 people. This also allows valid comparisons with other states with different population sizes." The positivity rate indicates how hard or easy it is to find a case, which reflects both the spread of COVID-19 and how widespread testing is, says Adalja. "If the rate of positive tests is 20%, you don't have to look hard to find a case, versus 1%, which means you have to do a lot of tests to get one positive one." The more COVID-19 spreads, the higher the positivity rate. But "context is important," Adalja says. "A 60% positivity rate may mean testing is only being done in a nursing home during an outbreak or a hospital where the most obvious cases are and not the general population where cases may be milder." Maryland's COVID-19 dashboard reports the daily positivity percentage, which is the percentage of positive tests and total testing volume since March. "When you're looking at testing, you want to know how many tests were done historically with the ability to compare back and know whether the number has gone up or down or is stable and the percentage that comes back positive," says Adalja. Maryland and Pennsylvania report a 7-day rolling average of the daily positivity percentages. "The 7-day average rate smooths out fluctuations during the week and is a better indicator of a trend than daily numbers," he says. The testing numbers often fluctuate, depending on where testing is done and when the labs report test results. A sudden spike in testing numbers may reflect a large number of tests done in a group setting such as a nursing home or prison on a single day. Laboratories and hospitals report test results on weekdays, so it's common to see those numbers decline on weekends.

Hospital Capacity A key goal during the coronavirus epidemic has been to "flatten the curve" to maintain local hospital capacity. After expected COVID- 19 surges, many hospitals limited surgeries and admissions to preserve their resources, including hospital beds, ventilators, and health care personnel. "You want to protect your hospital capacity. If that reaches 80%, you may have to stop admitting patients; otherwise, the hospital may be overwhelmed," says Mokdad, the IHME professor. To plan for surges and increase capacity, administrators should know the number of people who tested positive and were admitted to the hospital with symptoms of COVID-19, he says. Knowing the number of beds available also helps hospitals plan for surges. Pennsylvania's COVID-19 dashboard has a hospital preparedness page that lists the number of hospitalized

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COVID-19 patients and the number and percentage of available beds by unit, including intensive care, medical/surgical, and airborne isolation. Pennsylvania's dashboard also reports the number of ventilators COVID-19 patients and non-COVID-19 patients use daily. States like Illinois list the recovery rate from COVID-19 on their dashboards. In Illinois, the recovery rate of 95% is calculated as the recovered cases divided by recovered cases plus confirmed deaths. "This [metric] is important because it indicates the quality of medical care and the severity of disease," says Mokdad.

Deaths The ultimate goal of any epidemic response is to save lives, so monitoring death counts due to COVID-19 is important, especially when testing is limited, according to the Johns Hopkins University Coronavirus Resource Center, which developed management metrics for cities. For example, states count "probable" or "presumptive" COVID-19 deaths when cases are not confirmed with a positive test but are based on symptoms and medical history. For example, New York added 3,700 presumptive deaths in one day in April when testing was more limited, says Mokdad. The IHME says daily deaths are "the best indicator of the progression of the pandemic, although there is generally a 17- to 21-day lag between infection and deaths."

T-Cell-Based Vaccine Effective against Multiple Influenza Virus Strains Source: https://www.genengnews.com/news/t-cell-based-vaccine-effective-against-multiple-influenza-virus-strains/

Sep 24 – Scientists at the University of Wisconsin (UW)-Madison say they have some new insights into an alternative vaccine approach that provides broader protection against seasonal influenza. In a study, “Programming Multifaceted Pulmonary T Cell Immunity by Combination Adjuvants,” published in Cell Reports Medicine, researchers described a T-cell-based vaccine strategy that reportedly is effective against multiple strains of influenza virus. The experimental vaccine, administered through the nose, delivered long-lasting, multi-pronged protection in the lungs of mice by rallying T cells that eliminate viral invaders through an immune response. “Induction of protective mucosal T-cell memory remains a formidable challenge to vaccinologists. Using a combination adjuvant strategy that elicits potent CD8 and CD4 T-cell responses, we define the tenets of vaccine-induced pulmonary T-cell immunity. An acrylic-acid-based adjuvant (ADJ), in combination with Toll-like receptor (TLR) agonists glucopyranosyl lipid adjuvant (GLA) or CpG, promotes mucosal imprinting but engages distinct transcription programs to drive different degrees of terminal differentiation and disparate polarization of TH1/TC1/TH17/TC17 effector/memory T cells,” the investigators wrote. “Combination of ADJ with GLA, but not CpG, dampens T-cell receptor (TCR) signaling, mitigates terminal differentiation of effectors, and enhances the development of CD4 and CD8 TRM cells that protect against H1N1 and H5N1 influenza viruses. Mechanistically, vaccine-elicited CD4 T cells play a vital role in optimal programming of CD8 TRM and viral control. Taken together, these findings provide further insights into vaccine-induced multifaceted mucosal T-cell immunity with implications in the development of vaccines against respiratory pathogens, including influenza virus and SARS-CoV-2.” The research suggests a potential strategy for developing a universal flu vaccine, “so you don’t have to make a new vaccine every year,” explained Marulasiddappa Suresh, DVM, a professor of immunology in the School of Veterinary Medicine who led the research. The findings also aid understanding of how to induce and maintain T-cell immunity in the respiratory tract, a knowledge gap that has constrained the development of immunization strategies. The researchers believe the same approach could apply to several other respiratory pathogens, including the novel coronavirus that causes COVID-19. “We don’t currently have any vaccine for humans on the market that can be given into the mucosa and stimulate T-cell immunity like this,” said Suresh, who is also a veterinarian with specialty training in studying T-cell responses to viral infections. The strategy addresses the Achilles’ heel of flu vaccines, which is to achieve specific antibody responses to different circulating influenza strains annually, by harnessing T-cell immunity against multiple strains. In particular, the new approach calls into action tissue-resident memory T-cells, or TRM cells, which reside in the airways and lining of lung epithelial cells and combat invading pathogens. Like elite soldiers, TRM cells serve as front line defense against infection. “We didn’t previously know how to elicit these tissue-resident memory cells with a safe protein vaccine, but we now have a strategy to stimulate them in the lungs that will protect against influenza,” explained Suresh. “As soon as a cell gets infected, these memory cells will kill the infected cells and the infection will be stopped in its tracks before it goes further.”

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Flu vaccines work by arming the immune system with an enhanced ability to recognize and fight off the flu virus. Vaccines introduce proteins found on the surface of flu viruses, prompting the immune system to produce antibodies that are primed to react should the virus attack. However, because strains must be predicted ahead of flu season in order to produce vaccines, the vaccine in any given year may not completely match the viral strains in circulation that season. Flu viruses frequently mutate and can differ across time and from region to region. In addition, protection is neither long-lasting nor universal. “Even though current vaccines that people get annually stimulate antibody responses, these antibodies don’t cross-protect,” noted Suresh. “If there is a new flu strain not found in that year’s vaccine, the antibodies that we generated last year won’t be able to protect. That’s when pandemics happen because there is a completely new strain for which we have no antibodies. That is a really big problem in the field.” The vaccine developed by Suresh and his team is directed against an internal protein of influenza, specifically nucleoprotein. This protein is conserved between flu strains, meaning its genetic sequences are similar across different strains of flu. The vaccine also utilizes a special combination of adjuvants, that enhance an immune response, which the researchers developed to stimulate protective T cells in the lungs. These adjuvants spur T cells to form into different subtypes—in the case of the experimental flu vaccine, memory helper T cells and killer T cells. By doing so, the vaccine leverages multiple modes of immunity. Researchers demonstrated in a mouse model of influenza that the vaccine provides long-lasting immunity—at least 400 days after vaccination—against multiple flu strains. They will next test the vaccine in ferrets and nonhuman primates, two animal models of influenza research more biologically similar to human infection and transmission. The vaccine’s combination of adjuvants makes it adaptable to other pathogens and “expands the toolbox” for vaccine research, noted Suresh. He and his team have devised ways to program immunity to target multiple respiratory viruses. They are currently testing the same vaccine strategy against tuberculosis, which infects more than 10 million people globally each year, and human respiratory syncytial virus, or RSV, a major cause of lower respiratory tract infections during infancy and childhood. The researchers believe the same vaccine technology can be applied against SARS-CoV-2, the coronavirus that causes COVID-19. “Based on the COVID-19 immunology, we know this vaccine strategy would most likely work,” said Suresh. The team is now developing an experimental vaccine against COVID-19 and conducting laboratory tests to measure its effectiveness in mice and hamsters, animal models for COVID-19. Initial unpublished studies in mice show that the vaccine stimulates strong T- cell immunity against COVID-19 in the lungs. Along with its adaptability, this vaccine approach may harbor important safety benefits, continued Suresh. Typically, long-lasting T- cell immune responses are stimulated by live vaccines. For instance, the measles, mumps, and chickenpox vaccines administered worldwide are live, replicating vaccines, essentially benign versions of the pathogenic organism. These live vaccines stimulate strong, almost lifelong immunity. However, they can’t typically be given to pregnant or immunocompromised individuals due to health risks. In the case of the UW-Madison team’s vaccine, because it is a protein vaccine and not a live vaccine, it should be safe for delivery to those who are pregnant or immunocompromised—an advantage in delivering protection to a wider patient population. Suresh added that in recent years, vaccine development efforts have shifted away from live vaccines toward protein vaccines because an increasing number of people are living with compromised immune systems due to chemotherapy, radiation treatments, or conditions such as HIV/AIDS. “Previously, we didn’t know how to induce T-cell immunity in the lung without live viruses,” explained Suresh. “If we cleverly use a combination adjuvant, which we have developed, you can induce T-cell immunity that should stay in the lungs and protect longer.”

Highly effective antibodies against the coronavirus were identified Joint Press Release Charité – Universitätsmedizin Berlin and German Center for Neurodegenerative Diseases Source: https://www.charite.de/en/service/press_reports/artikel/detail/covid_19_berlin_scientists_lay_basis_for_a_passive_vaccination/

Researchers at the German Center for Neurodegenerative Diseases (DZNE) and Charité - Universitätsmedizin Berlin have identified highly effective antibodies against the coronavirus SARS-CoV-2 and are now pursuing the development of a passive vaccination. In this process, they have also discovered that some SARS-CoV-2 antibodies bind to tissue samples

www.cbrne-terrorism-newsletter.com 75 HZS C2BRNE DIARY – October 2020 from various organs, which could potentially trigger undesired side effects. They report their findings in the scientific journal Cell1. Initially, the scientists isolated almost 600 different antibodies from the blood of individuals who had overcome COVID-19, the disease triggered by SARS-CoV-2. By means of laboratory tests, they were able to narrow this number down to a few antibodies that were particularly effective at binding to the virus. Next, they produced these antibodies artificially using cell cultures. The identified so- called neutralizing antibodies bind to the virus, as crystallographic analysis reveals, and thus prevent the pathogen from entering cells and reproducing. In addition, virus recognition by antibodies helps immune cells to eliminate the pathogen. Studies in hamsters – which, like humans, are susceptible to infection by SARS-CoV-2 – confirmed the high efficacy of the selected antibodies: “If the antibodies were given after an infection, the hamsters developed mild disease symptoms at most. If the antibodies were applied preventively - before infection - the animals did not get sick,” said Dr. Jakob Kreye, coordinator of the current research project. The DZNE scientist is one of the two first authors of the current publication. Treating infectious diseases with antibodies has a long history. For COVID-19, this approach is also being investigated through the administration of plasma derived from the blood of recovered patients. With the plasma, antibodies of donors are transferred. “Ideally, the most effective antibody is produced in a controlled manner on an industrial scale and in constant quality. This is the goal we are pursuing,” said Dr. Momsen Reincke, also first author of the current publication. “Three of our antibodies are particularly promising for clinical development,” explained Prof. Dr. Harald Prüss, a research group leader at the DZNE and also a senior physician at the Clinic for Neurology with Experimental Neurology at Charité - Universitätsmedizin Berlin. “Using these antibodies, we have started to develop a passive vaccination against SARS-CoV-2.” Such a project requires cooperation with industrial partners. That is why the scientists are collaborating with Miltenyi Biotec. In addition to the treatment of patients, preventive protection of healthy individuals who have had contact with infected persons is also a potential application. How long the protection lasts will have to be investigated in clinical studies. “This is because, unlike in active vaccination, passive vaccination involves the administration of ready-made antibodies, which are degraded after some time,” Prof. Prüss said. In general, the protection provided by a passive vaccination is less persistent than that provided by an active vaccination. However, the effect of a passive vaccination is almost immediate, whereas with an active vaccination it has to build up first. “It would be best if both options were available so that a flexible response could be made depending on the situation.” Kreye, Reincke, Prüss and colleagues usually deal with autoimmune diseases of the brain, in which antibodies erroneously attack neurons. “In the face of the COVID-19 pandemic, however, it was obvious to use our resources also in other ways,” said Prof. Prüss. For the current project, the researchers benefit from a project funded by the Helmholtz Association: the “BaoBab Innovation Lab”.

1 A therapeutic non-self-reactive SARS-CoV-2 antibody protects from lung pathology in a COVID-19 hamster model, Jakob Kreye, S Momsen Reincke et al., Cell (2020), DOI: https://doi.org/10.1016/j.cell.2020.09.049

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Within this framework, they are developing and refining technologies for the characterization and production of antibodies, which they are now applying. “Now, we are working with our industrial partner to establish the conditions that will allow for the most effective large-scale production of the antibodies we have identified,” said Prüss. “The next step is clinical trials, that is testing in humans. However, this can not be expected before the end of this year at the earliest. The planning for this has already started.” During their investigations, the researchers made a further discovery: some of the particularly effective antibodies against the coronavirus specifically attached to proteins of the brain, heart muscle and blood vessels. In tests with tissue samples from mice, several of the neutralizing antibodies exhibited such a cross-reactivity. Thus, they were excluded from the development of a passive vaccination. “These antibodies bind not only to the virus, but also to proteins in the body that have nothing to do with the virus. Future research is needed to analyse whether the associated tissues could potentially become targets of attacks by the own immune system,” said Prof. Prüss. Whether these laboratory findings are relevant for humans cannot be predicted at present. “On the one hand, we need to be vigilant in order to detect any autoimmune reactions that may occur in the context of COVID-19 and vaccinations at an early stage. On the other hand, these findings can contribute to ensure the development of an even safer vaccine,” the scientist said. For the current studies, the DZNE research group lead by Prof. Prüss collaborated closely with the Department of Infectious Diseases and Respiratory Medicine at the Charité and the Institute of Virology at the Campus Charité Mitte. The Institutes of Virology and Veterinary Pathology at the Freie Universität Berlin and the Scripps Research Institute in the US were also significantly involved.

Lessons learnt from easing COVID-19 restrictions: an analysis of countries and regions in Asia Pacific and Europe Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)32007-9/fulltext

Sep 24 – The COVID-19 pandemic is an unprecedented global crisis. Many countries have implemented restrictions on population movement to slow the spread of severe acute respiratory syndrome coronavirus 2 and prevent health systems from becoming overwhelmed; some have instituted full or partial lockdowns. However, lockdowns and other extreme restrictions cannot be sustained for the long term in the hope that there will be an effective vaccine or treatment for COVID-19. Governments worldwide now face the common challenge of easing lockdowns and restrictions while balancing various health, social, and economic concerns. To facilitate cross-country learning, this Health Policy paper uses an adapted framework to examine the approaches taken by nine high-income countries and regions that have started to ease COVID-19 restrictions: five in the Asia Pacific region (ie, Hong Kong [Special Administrative Region], Japan, New Zealand, Singapore, and South Korea) and four in Europe (ie, Germany, Norway, Spain, and the UK). This comparative analysis presents important lessons to be learnt from the experiences of these countries and regions. Although the future of the virus is unknown at present, countries should continue to share their experiences, shield populations who are at risk, and suppress transmission to save lives.

What can we expect from first-generation COVID-19 vaccines? By Malik Peiris and Gabriel M Leung Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31976-0/fulltext

Sep 21 – A first generation of COVID-19 vaccines is expected to gain approval as soon as the end of 2020 or early 2021. A popular assumption is that these vaccines will provide population immunity that can reduce transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and lead to a resumption of pre-COVID-19 “normalcy”. Given an initial reproduction number of around 2·2, which has since been revised to as high as about 4, and taking into account overdispersion of infections, perhaps about 25–50% of the population would have to be immune to the virus to achieve suppression of community transmission. Multiple COVID-19 vaccines are currently in phase 3 trials with efficacy assessed as prevention of virologically confirmed disease. WHO recommends that successful vaccines should show disease risk reduction of at least 50%, with 95% CI that true vaccine efficacy exceeds 30%. However, the impact of these COVID-19 vaccines on infection and thus transmission is not being assessed. Even if vaccines were able to confer protection from disease, they might not reduce transmission similarly.

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Challenge studies in vaccinated primates showed reductions in pathology, symptoms, and viral load in the lower respiratory tract, but failed to elicit sterilising immunity in the upper airways. Sterilising immunity in the upper airways has been claimed for one vaccine, but peer-reviewed publication of these data is awaited. There have been reports of virologically confirmed SARS-CoV-2 re-infection of previously infected individuals, but the extent of such re-infection is unclear. Whether re-infection is associated with secondary spread is unknown. The immunological correlates of protection from SARS-CoV-2 infection and COVID-19 have yet to be elucidated. Pre-existing neutralising antibody seemed to have afforded protection against re-infection in people on board a fishing vessel where there was an outbreak of SARS-CoV-2 with a high infection attack rate. In animal models, passive antibody transfer protected against COVID-19, whereas neutralising antibody correlated with protection after inoculation. However, the roles of mucosal immunity, other biological antibody activities (eg, antibody-dependent cellular cytotoxicity), and T cells in protection conferred by natural infection or passive immunisation are unclear. The prevalence and duration of neutralising antibody responses after natural infection remain to be defined by gold-standard neutralisation assays that use live virus rather than pseudotype neutralising assays or non-functional ELISA assays. The duration of protection against re-infection with seasonal human coronaviruses might last for less than a year. Middle East respiratory syndrome coronavirus (MERS-CoV) re-infection occurs in dromedary camels, the natural host of that virus. Whether re-infected camels are as infectious as those with primary infections is not known. The observation that MERS-CoV is enzootic in dromedary populations despite high (>90%) seroprevalence in juvenile and adult camels implies that virus transmission may not be functionally interrupted by previous infection. Also relevant is how influenza vaccines can reduce disease transmission, whereas inactivated polio vaccines are effective at protecting from disease but have less effect on reduction of faecal shedding of poliomyelitis virus and thus possibly on transmission. These observations suggest that we cannot assume COVID-19 vaccines, even if shown to be effective in reducing severity of disease, will reduce virus transmission to a comparable degree. The notion that COVID-19-vaccine-induced population immunity will allow a return to pre-COVID-19 “normalcy” might be based on illusory assumptions. Another important consideration is COVID-19 vaccine allocation strategy. First principles would preferentially allocate vaccine supplies to people at high risk of severe morbidity and mortality. Preliminary model-informed analyses support this theoretical inference. However, vaccine allocation perspectives in addition to utilitarian considerations are important. The US National Academy of Medicine's Preliminary Framework for Equitable Allocation of COVID-19 Vaccines identified other foundational criteria, such as equal regard, mitigation of health inequities, fairness, and transparency, that should also determine vaccine allocation. Alongside the risks of severe morbidity and mortality and of disease transmission, this framework stipulates two additional criteria for equitable vaccine allocation—namely, risks of acquiring infection and of negative societal impact. Front-line health-care and essential workers, such as school teachers, belong in both these latter groups. Policy makers must be vigilant of the possible impact of vaccine hesitancy. In the COVID-19 response, the activities of some politicians have been incompatible with science and risk further eroding vaccine confidence among the general public. The potential disruption of a proportion of people declining vaccine uptake could be substantial. The likely heterogeneity of such abreactions to vaccination roll-outs between countries and across partisan divides within nations should not be underestimated. Finally, if international travel were to fully recommence, vaccine allocation to different countries with varying means of access will require careful deliberation, based on moral grounds and because no country will be truly protected from COVID-19 until virtually the entire world is. Notwithstanding these caveats, COVID-19 vaccines are needed, even if they have minimal impact on transmission and despite the challenges of vaccine allocation. What such vaccines are likely to achieve might not be herd immunity. If so, strategies for how we use such vaccines would have to be based on other considerations. Will vaccines that protect healthy young adults also protect groups vulnerable to severe disease such as older adults and those with comorbidities? Influenza vaccines are less effective in older populations than in younger populations, partly due to immune senescence, which might similarly affect COVID-19 vaccines. However, the so-called original antigenic sin in influenza vaccines that arises from sequential infections by or vaccinations with antigenically closely related strains is not relevant to coronaviruses. If COVID-19 vaccines have acceptable effectiveness in reducing morbidity and mortality in high-risk groups, they would have an important role, irrespective of impact on transmission and population immunity. If high-risk populations can be shielded by vaccination, COVID-19 control measures could be recalibrated. Crucially, it will be important to communicate to policy

www.cbrne-terrorism-newsletter.com 78 HZS C2BRNE DIARY – October 2020 makers and the general public that first-generation vaccines are only one tool in the overall public health response to COVID-19 and unlikely to be the ultimate solution that many expect.

We May Finally Know a Molecular Reason Why COVID-19 Is So Deadly, But Only for Some Source: https://www.sciencealert.com/these-critical-differences-in-our-immune-systems-help-explain-covid-s-fickle-touch

Sep 25 – Among the million or so lives lost to COVID-19 there are stories that defy understanding. Healthy bodies, young and in their prime, succumb to the virus as easily as if they were among the most vulnerable. While for others in their age group, the virus only produces mild symptoms - if any. Across two new studies, researchers have identified a crucial immune system mechanism that could help explain why the virus is so lethal - but only for some people. The research also offers the first molecular explanation for why men seem to be impacted by the virus more severely than women. Both papers point to type I interferons (IFNs) as playing a role in this crucial difference in COVID-19 outcomes. IFNs are proteins that infected cells produce in order to help stop the spread of whatever's infecting them. But, for some people, their job is interrupted. One of the new studies showed that more than 10 percent of healthy people who ended up with severe COVID-19 symptoms have antibodies that attack the patient's own IFNs and stop them properly fighting the SARS-CoV-2 virus. The other study looked at patients who were hospitalised with severe symptoms - some of them still in their 20s - and found that at least another 3.5 percent of carried genetic mutations that stop IFNs working properly. While this potential mechanism would only explain a proportion of COVID-19's most serious cases, it just might be a discovery that could still save tens, if not hundreds of thousands of lives. "These findings provide compelling evidence that the disruption of type I interferon is often the cause of life-threatening COVID-19," says physician Jean-Laurent Casanova, head of the St. Giles Laboratory of Human Genetics of Infectious Diseases at The Rockefeller University. "And at least in theory, such interferon problems could be treated with existing medications and interventions." Collaborating with a large international team of researchers as part of the COVID Human Genetic Effort, Casanova and his colleagues identified an antibody that errantly neutralised one or more of their body's own IFN proteins in at least 101 of the 987 COVID-19 patients they tested (10.2 percent). It's not the first time we've seen the immune system sabotage itself and stop interferons from doing their jobs properly. Some bacterial infections, such as those caused by species of Staphylococcus, often increase in severity when the body's production of antibodies turn against its own interferon defence. This self-sabotage has been noted in people treated with interferon for infections such as hepatitis, as well as in women with the autoimmune disease lupus. Finding it just might explain as many as one in 10 of COVID's most life-threatening, providing not just a means of treatment, but of better identifying who in our community is most at risk. It also goes some way to explaining another perplexing coronavirus mystery. "Interestingly, 94 percent of patients with these neutralising auto-antibodies were male, which may explain why men are more susceptible to getting severe COVID-19," says Stuart Tangye, head of the Oceania node of the COVID Human Genomic Effort. The second study found genes for the interferon proteins themselves could also be working against the body's interests. Comparing the genes of 659 patients with life-threatening cases of COVID-19 with 534 individuals with asymptomatic or benign infections resulted in the identification of 13 abnormalities in sequences known to be integral to IFN's anti-influenza activity. These 'loss of function' mutations were only spotted in 23 of the patients, or around 3.5 percent of the group, but the research makes a strong case that even in this small fraction of the population, a breakdown in this critical immune pathway could be deadly in an otherwise healthy patient. "The way SARS-CoV-2 affects people differently has been puzzling. The virus can cause a symptom-free infection and go away quietly, or it can kill in a few days," says medical geneticist John Christodoulo from the Murdoch Children's Research Institute in Australia. "The changes compromised their ability to protect against COVID-19 infection by impairing patients' ability to make type I interferon."

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Combined, the two studies fill in critical pieces of the coronavirus puzzle, clarifying how it invades and destroys in a seemingly whimsical manner. Better treatments and diagnostics aside, they also expose a familiar side to the virus: One though deadly, isn't entire novel. As significant as the findings are, it's hard not to think of the vast numbers of dead who only recently were in peak health, confident that they were among the fraction who'd suffer little, if at all. Among them, there are still mysteries to be solved.

 This research was published in Science, here and here.

An Anonymous Nurse Speaks Out: The RT-PCR Test is Totally Unreliable, It Does not Detect the Virus. Source: https://www.globalresearch.ca/an-anonymous-nurse-speaks-out-the-rt-pcr-test-is-totally-unreliable-it- does-not-detect-the-virus/5724829

Sep 24 – I work in the healthcare field. Here’s the problem, we are testing people for any strain of a Coronavirus. Not specifically for COVID-19. There are no reliable tests for a specific COVID-19 virus. There are no reliable agencies or media outlets for reporting numbers of actual COVID-19 virus cases. This needs to be addressed first and foremost. Every action and reaction to COVID-19 is based on totally flawed data and we simply cannot make accurate assessments. This is why you’re hearing that most people with COVID-19 are showing nothing more than cold/flu like symptoms. That’s because most Coronavirus strains are nothing more than cold/flu like symptoms. The few actual novel Coronavirus cases do have some worse respiratory responses, but still have a very promising recovery rate, especially for those without prior issues. The ‘gold standard’ in testing for COVID-19 is laboratory isolated/purified coronavirus particles free from any contaminants and particles that look like viruses but are not, that have been proven to be the cause of the syndrome known as COVID-19 and obtained by using proper viral isolation methods and controls (not PCR that is currently being used or Serology /antibody tests which do not detect virus as such). PCR basically takes a sample of your cells and amplifies any DNA to look for ‘viral sequences’, i.e. bits of non-human DNA that seem to match parts of a known viral genome. The problem is the test is known not to work. It uses ‘amplification’ which means taking a very very tiny amount of DNA and growing it exponentially until it can be analyzed. Obviously, any minute contaminations in the sample will also be amplified leading to potentially gross errors of discovery. Additionally, it’s only looking for partial viral sequences, not whole genomes, so identifying a single pathogen is next to impossible even if you ignore the other issues. The Mickey Mouse test kits being sent out to hospitals, at best, tell analysts you have some viral DNA in your cells. Which most of us do, most of the time. It may tell you the viral sequence is related to a specific type of virus – say the huge family of coronavirus. But that’s all. The idea these kits can isolate a specific virus like COVID-19 is nonsense.And that’s not even getting into the other issue – viral load. If you remember the PCR works by amplifying minute amounts of DNA. It therefore is useless at telling you how much virus you may have. And that’s the only question that really matters when it comes to diagnosing illness. Everyone will have a few virus kicking round in their system at any time, and most will not cause illness because their quantities are too small. For a virus to sicken you you need a lot of it, a massive amount of it. But PCR does not test viral load and therefore can’t determine if a osteogenesis is present in sufficient quantities to sicken you. If you feel sick and get a PCR test any random virus DNA might be identified even if they aren’t at all involved in your sickness which leads to false diagnosis. And coronavirus are incredibly common. A large percentage of the world human population will have covi DNA in them in small quantities even if they are perfectly well or sick with some other pathogen. Do you see where this is going yet? If you want to create a totally false panic about a totally false pandemic – pick a coronavirus.

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They are incredibly common and there’s tons of them. A very high percentage of people who have become sick by other means (flu, bacterial pneumonia, anything) will have a positive PCR test for covi even if you’re doing them properly and ruling out contamination, simply because covis are so common. There are hundreds of thousands of flu and pneumonia victims in hospitals throughout the world at any one time. All you need to do is select the sickest of these in a single location – say Wuhan – administer PCR tests to them and claim anyone showing viral sequences similar to a coronavirus (which will inevitably be quite a few) is suffering from a ‘new’ disease. Since you already selected the sickest flu cases a fairly high proportion of your sample will go on to die. You can then say this ‘new’ virus has a CFR higher than the flu and use this to infuse more concern and do more tests which will of course produce more ‘cases’, which expands the testing, which produces yet more ‘cases’ and so on and so on. Before long you have your ‘pandemic’, and all you have done is use a simple test kit trick to convert the worst flu and pneumonia cases into something new that doesn’t actually exist. Now just run the same scam in other countries. Making sure to keep the fear message running high so that people will feel panicky and less able to think critically. Your only problem is going to be that – due to the fact there is no actual new deadly pathogen but just regular sick people you are mislabelling – your case numbers, and especially your deaths, are going to be way too low for a real new deadly virus pandemic. But you can stop people pointing this out in several ways. 1. You can claim this is just the beginning and more deaths are imminent. Use this as an excuse to quarantine everyone and then claim the quarantine prevented the expected millions of dead. 2. You can tell people that ‘minimizing’ the dangers is irresponsible and bully them into not talking about numbers. 3. You can talk crap about made up numbers hoping to blind people with pseudoscience. 4. You can start testing well people (who, of course, will also likely have shreds of coronavirus DNA in them) and thus inflate your ‘case figures’ with ‘asymptomatic carriers’ (you will of course have to spin that to sound deadly even though any virologist knows the more symptom-less cases you have the less deadly is your pathogen. Take these simple steps and you can have your own entirely manufactured pandemic up and running in weeks. They can not “confirm” something for which there is no accurate test.”

EDITOR’S COMMENT: Forget “anonymous” and “nurse” from the title of this article; think only about the content and make your own conclusions about the infamous “golden standard” of the current ongoing pandemic. I think that automatically a big “why” is generated.

The Geochanvre mask is a bio-compostable mask in natural hemp fibers Source: https://www.designboom.com/design/geochanvre-mask-biocompostable-hemp-fibers-08-20-20/

Geochanvre is a french industrial company using sustainable development with zero-waste industrialized production of natural, biodegradable, and biocompostable geotextiles for planting, and packaging. Following the COVID-19 pandemic, the company saw that their compostable material could also be used as a safe filter for masks. mobilized to respond to the health emergency, geochanvre has put its know-how as a producer of vegetable felt at the service of the protection of people. Geochanvre states that they have created the first ecological and ethical consumer mask. Designed and produced in france, the mask is biocompostable, composed of a 100% vegetable filtering felt in natural french hemp fibers, with performance

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controlled by the DGA, conform to the UNS 2 category, and sold ready-to-use or as a kit depending on your needs.

Advantages of the geochanvre mask include 89% filtration efficiency level at 3 μm particles, air permeability of 459 liters / m2 / sec for depression of 100 Pa, and a natural, local compostable product. The single-use mask features filtering felt hemp without glue, additives or treatment, lined with a dark protective veil in compostable cornstarch. the elastic band used to fix the mask on your face is also recyclable.

Regarding price, the geochanvre mask is completely on the norm of bio-compostable masks costing less than one euro each. You can order from 50 to 250 to 400 masks, where the box of 50 is sold for only €34.29. they can also be customized and have your logo on the front.

The Biothreat After COVID-19: Engineered Pathogens, More Zoonotic Outbreaks By Bridget Johnson Source: https://www.hstoday.us/subject-matter-areas/surveillance-protection-detection/the-biothreat-after-covid-19-easily- engineered-pathogens-more-zoonotic-outbreaks/

Sep 25 – Biotech experts cautioned that the next pandemic could be worse than COVID-19 as emerging pathogens increasingly jump from animals to humans, the number of outbreaks grows as government preparedness lags, and nefarious actors can use the same advancements as researchers to “engineer pathogens with increasing sophistication” and “catastrophic” results. Six months into the national emergency due to the coronavirus pandemic, the Bipartisan Commission on Biodefense held a virtual meeting on “The Biological Event Horizon: No Return or Total Resilience,” recorded a week ago and released Thursday. Formerly known as the Blue Ribbon Study Panel on Biodefense, the group was formed in 2014 and the following year issued the benchmark report A National Blueprint for Biodefense: Leadership and Major Reform Needed to Optimize Efforts. Former Homeland Security Secretary Tom Ridge, co-chairman of the commission, said that 2015 report “tried to calculate economic cost of our country’s failure to protect itself” but COVID-19 and more than 200,000 American deaths from the virus so far have showed they “grossly underestimated” pandemic impacts. “In six months, it is breathtaking in its scope,” Ridge said. “And as visionary as this group was and as committed as we were to making a difference, I don’t think anyone ever imagined that we’d see a replication of the Spanish flu.” Ridge’s co-chairman, former Sen. Joe Lieberman (I-Conn.), said the commission’s warnings pre-COVID were likened to “saying ‘the British are coming, the British are coming’… but it was hard to get anybody’s attention.” “Of course, when the Brits were actually coming now we have experienced this horrendous pandemic — and hopefully it will generate the kind of support for preventive and protective activity in the future,” he added. Jaime Yassif, a senior fellow in Global Biological Policy and Programs at the Nuclear Threat Initiative, said it is now easier to read, write, and edit DNA and RNA, making it “easier to edit individual genes and genomes for a wide variety of viruses and bacteria including pathogens.” “You can tinker with a pathogen and make it resistant to existing medical countermeasures,” she said. “…Notwithstanding the fact that there is risk here there are a number of researchers that are actively using these tools to do exactly this to modify and synthesize pathogens.” In 2017, she noted, a group of Canadian researchers used $100,000 of mail-order DNA to synthesize horsepox, which is related to smallpox. By publishing a paper on it, they created an “information hazard” that could assist others in doing something similar, she added, causing controversy in the biosecurity community. “It’s making it easier for people with less tacit knowledge and skills to do these kinds of things.” “Lowering technical barriers over time means that a wider range of actors can engineer pathogens with increasing sophistication,” Yassif said, with “the potential perhaps in the long term to create particularly damaging pathogens that could have catastrophic consequences.”

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The activities of Aum Shinrkyo — the Japanese doomsday cult that unsuccessfully sprayed Tokyo with anthrax spores two years before their deadly sarin attack on the subway — and the 2001 anthrax letters in the United States show various actors have the intent to unleash bioterror, she said, “so this is a question of changing potential capabilities over time, and then there’s also an increased risk of accidental release of an engineered pathogen.” “The lower technical barriers that we’re seeing might shape the cost-benefit calculations of some nations as they think about whether or not they want to explore the possibility of developing biological weapons,” Yassif noted. DNA synthesis screening guidelines from the federal government are positive, she said, “but it’s just not moving fast enough and it’s not broad enough in scope to keep pace with these rapid advances that we’re seeing.” “I think there are basically two goals that we’re after — one is to ensure that the legitimate global bioscience research and development enterprise is not exploited, defended against exploitation by malicious actors that might be seeking to cause harm with weapons. And we also want to take steps to reduce accidental laboratory release risks for engineered pathogens — even in legitimate settings but potentially other types of settings as well — because they could have catastrophic consequences,” she continued. “So how do we do that? So I would argue that we need a layered defense — there’s no single thing we can do that’s going to be a silver bullet but there are a number of intervention points throughout the research and development lifecycle in the biosciences and biotechnology.” Sohini Ramachandran, associate professor of biology, director of graduate studies for the Center for Computational Molecular Biology, and associate professor of computer science at Brown University, develops computational methods to analyze large biological datasets and has found that the impact of zoonotic diseases like COVID-19 is increasing over time, surpassing that of human-specific infectious diseases. “Not only is the number of emerging infectious diseases increasing with time but also the number of outbreaks appears to be increasing with time,” she said, adding that the “biggest contributing factors to the rise in zoonotic diseases are climate change and reductions in biodiversity from deforestation.” “The sale and consumption of wild and rare animals also often leads to outbreaks; these factors all drive a well-known inverse relationship between disease richness and latitude, meaning that people living closer to the tropics experience and will continue to experience more outbreaks in a warming world, and the temporal duration of seasonal illnesses like influenza will continue to change and likely expand in a warming world,” she said. Ramachandran noted that the 2019-2020 flu season “was highly unusual in that both strains A and B overlapped for much longer than normal.” She advocated for “a national data-driven emerging infectious disease watch force” as surveillance as “the key to preventing future pandemics — ideally, such a watch force would advise many government offices at various levels of government, develop policies like travel restrictions to protect U.S. residents and also centralized outbreak data, and develop academic collaborations for academic researchers to analyze those data.” Vaccination should also be promoted as the U.S. has seen rising cases of mumps and measles despite the availability of immunization. Nita Madhav, chief executive officer, president, and board member of Metabiota, said that combining epidemiological expertise with these computational and risk management techniques for extreme events modeling and risk analysis “can really help us to drive forward this conversation — and especially when it comes to understanding epidemics the key to it is understanding the frequency and severity.” “As we heard, the frequency is increasing but these methods can still be used to allow us to understand what a one in 20 year event might look like or one in 50 year event or even a one in 200 year event and what level of resources would be needed to be adequately prepared and which mitigation strategies are likely to be most effective,” she said. Madhav stressed that pandemics “are not a one in 100 year event — I know a lot of people have been talking about this and it’s very tempting to think this way because there was a big flu pandemic in 1918, but this is largely a quirk of chance and every year there’s a chance that a bad pandemic can happen by its very definition. A one in 100 year event has a 1 percent chance of occurring in any year, and epidemics and pandemics are happening much more frequently.” COVID-19 “certainly is not going to be the last event and the next one could be even worse,” she added, noting how “the majority of these epidemics and pandemics are caused by diseases coming from animals and an unknown pool of reservoirs and there are millions of unknown viruses.” Madhav agreed that “there really is a need for something similar to the National Weather Service for epidemics and pandemics,” integrating epidemic forecasting and analytics “to have earlier indicators of epidemics and pandemics before they reach a state where it’s much more difficult to contain them.”

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“We also need to gain a better understanding of which pathogens might be most dangerous even before they spill over into humans,” she said. “…If we only learn one thing from this event it is the importance of early action and breaking out of the cycle of panic and neglect.” Madhav said she often hears companies saying they “just want to see like a hurricane track type of thing for this type of event.” “It’s very difficult to discern what the credible sources of information are and there’s such a plethora of it that it’s very difficult for the general public or decision makers to sift through all that,” she said. “And to have kind of a centralized voice that consolidates this information and makes it digestible, I think, would be something very important to have.” Ramachandran said such an entity would “definitely interact with intelligence agencies, with international partners, with the State Department, with the Department of Education.” She encouraged “curbing deforestation globally” as it’s “key to maintaining biodiversity and actually reduces the chance that spillover happens to humans.” And “especially the countries where there is this sort of rare exotic wildlife trade and these live slaughter markets, every government has an interest in curbing those because those also just lead to dangerous situations for humans there in close contact with exotic animals.” Yassif said the pandemic has been “a really instructive moment” that “highlights global vulnerability to high-consequence biological events.” “We need to really make a significant investment across the board to protect against these kinds of risks,” she said. “…We also really need to focus on long-term planning and look what’s coming coming 5 or 10 years down the road because it could be a significant risk, and that’s why we’re really focused on engineered biothreats that could come from deliberate or accidental releases. And I think there’s a lot of white space and there’s a really big hole in the sort of developing biosecurity norms of best practices and developing more robust governance approaches that really meaningfully reduce risk.” “Better intelligence for biological threats — it does exist, but there is significant room for improvement,” Yassif said. “There also needs to be better connectivity between the existing bioscience governance tools …and the law enforcement and security sector. They do exist, but operationally those connections are not as strong as they could be for this to really be effective.”

Bridget Johnson is the Managing Editor for Homeland Security Today.

Calling Out Bad Science Source: http://www.homelandsecuritynewswire.com/dr20200926-calling-out-bad-science

Sep 26 – Two weeks ago, Li-Meng Yan, Shu Kang, Jie Guan, and Shanchang Hu posted an article in which they claimed that certain features of the COVID-19 virus lend support to the theory that the virus was synthetic, that is, that it was made or modified in a lab rather than having evolved naturally. The article states that “SARS- CoV-2 shows biological characteristics that are inconsistent with a naturally occurring, zoonotic virus” and that “evidence shows that SARS-CoV-2 should be a laboratory product created by using bat coronaviruses ZC45 and/or ZXC21 as a template and/or backbone.”

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The article, which has not yet been peer-reviewed, is titled “Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route.” Because the contention that the virus was man made in a Chinese lab serves as a basis for wild conspiracy theories disseminated on social media, scientists at the Johns Hopkins Center for Health Security took it upon themselves to do an informal peer review of the article. The Johns Hopkins scientists’ detailed, page-by-page review of the article is unequivocal in its conclusions: the authors failed to provide accurate or supportive evidence to back up their claim. Moreover, the article contains many errors of both facts and interpretation, and some what the authors claim to be a supportive evidence for their claims in fact contradicts and undermines their assertions. The Johns Hopkins’s refutation of the article thoroughly details the errors in it and provides accurate information about each topic.

Here is the introduction to the Johns Hopkins critique of the posted article:

In Response: Yan et al. Preprint Examinations of the Origin of SARS-CoV-2 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of novel coronavirus disease 2019 (COVID-19), has caused more than 961,000 known deaths1 since it was reported to the World Health Organization on December 31, 2019. Determining the origin of the pandemic coronavirus is of great importance, not only to understand the mechanics of how the virus replicates and spreads but also to anticipate and prevent additional viruses from becoming future health security crises. If an origin can be found for SARS-CoV-2, steps can then be taken to prevent a similar pathway for other viruses to lead to a pandemic. For that reason, it is the responsibility of the scientific community to review and analyze data relating to the origin of SARS-CoV-2. Several analyses of the potential origin of SARS-CoV-2 have been published in scientific journals that provide peer review prior to publication.2,3,4,5,6,7,8,9 Peer review is central to the scientific process because scrutiny by experts allows for meaningful conclusions to be drawn about available data and reduces inappropriate extrapolation or misinterpretation. It is an imperfect process, often criticized for slowness, but peer review is a necessary part of building reliability in the scientific record. Complex scientific details are best understood and critiqued by others who are also experts in a technical field. When the audience for an article is broadened, even to a technical audience in an adjacent scientific field, data may appear smoother and less conflicting than it is in reality, leading to a blurring or skewing of its real meaning. In this document, we have undertaken a scientific review of a recent report, released as a preprint put forward by the Rule of Law Society, authored by Li-Meng Yan, Shu Kang, Jie Guan, and Shanchang Hu. The report, Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route, 10 presents a theory about the origin of SARS-CoV-2 but offers contradictory and inaccurate information that does not support their argument. As the report has not been submitted to a scientific peer-reviewed publication, which would provide the expert scrutiny expected by the scientific community and the larger public, we aim to provide an objective analysis of details included in the report, as would be customary in a peer-review process.

1. COVID-19 dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. Johns Hopkins University of Medicine Coronavirus Resource Center website. Accessed September 21, 2020. https://coronavirus.jhu.edu/map.html 2. Luan J, Jin X, Lu Y, Zhang L. SARS‐CoV‐2 Spike protein favors ACE2 from Bovidae and Cricetidae. J Med Virol. April 1, 2020. https://doi.org/10.1002/jmv.25817 3. Anderson KG, Rambaut A, Lipkin WI, Holmes EC, Garry RF. The proximal origin of SARA-CoV-2. Nat Med. 2020;26:450-452. https://doi.org/10.1038/s41591-020-0820-9 4. Zhou P, Yang Z-L, Wang X-G, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579:270- 273. https://doi.org/10.1038/s41586-020-2012-7 5. Leitner T, Kumar S. Where did SARS-CoV-2 come from? Mol Biol Evol. 2020;37(9):2463-2464. https://doi.org/10.1093/molbev/msaa162 6. Xia X. Extreme genomic CpG deficiency in SARS-CoV-2 and evasion of host antiviral defense. Mol Biol Evol. 2020;37(9):2699-2705. https://doi.org/10.1093/molbev/msaa094 7. Zhou H, Chen X, Hu T, et al. A novel bat coronavirus closely related to SARS-CoV-2 contains natural insertions at the S1/S2 cleavage site of the Spike protein. Curr Biol. 2020;30(11):2196-2203.e3. https://doi.org/10.1016/j.cub.2020.05.023 8. Zhang Y-Z, Holmes EC. A Genomic Perspective on the Origin and Emergence of SARS-CoV- 2. Cell. 2020;181(2):223-227. https://doi.org/10.1016/j.cell.2020.03.035 9. Tang Z, Wu C, Li X, et al. On the origin and continuing evolution of SARS-CoV-2. Natl Sci Rev. 2020;7(6):1012-1023. https://doi.org/10.1093/nsr/nwaa036

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10. Yan L-M, Kang S, Guan J, Hu S. Unusual Features of the SARS-CoV-2 Genome Suggesting Sophisticated Laboratory Modification Rather Than Natural Evolution and Delineation of Its Probable Synthetic Route. New York: Rule of Law Society & Rule of Law Foundation; 2020.

A 2009 BMW 5 Series with custom COVID19 number plates has been left 'abandoned' at Adelaide Airport (AUS) for months.

SARS-CoV-2 Seems to Block Some Pain Signals. Here's Why This Is Important By Rajesh Khanna Source: https://www.sciencealert.com/sars-cov-2-appears-to-stop-us-feeling-pain-which-could-be-why-it-s-spreads-so-easily

Sep 26 – Imagine being infected with a deadly virus that makes you impervious to pain. By the time you realize you are infected, it's already too late. You have spread it far and wide. Recent findings in my lab suggest that this scenario may be one reason that people infected with SARS-CoV-2, the virus causing COVID-19, may be spreading the disease without knowing it. Most accounts to date have focused on how the virus invades cells via the ACE2 protein on the surface of many cells. But recent studies, which have not yet been peer-reviewed, suggest there is another route to infecting the cell that enables it to infect the nervous system. This led my research group to uncover a link between a particular cellular protein and pain – an interaction that is disrupted by the coronavirus. Our research has now been peer-reviewed and will be published in the journal PAIN. I am a scientist who studies how proteins on cells trigger pain signals that are transmitted through the body to the brain. When these proteins are active, the nerve cells are talking to each other. This conversation occurs at deafening levels in chronic pain. So, by studying what causes the excitability of nerve cells to change, we can begin to unravel how chronic pain becomes established. This also allows us to design ways to mute this conversation to blunt or stop chronic pain.

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My laboratory has a longstanding interest in designing nonopioid-based alternatives for pain management.

Linking SARS-CoV-2 and pain You might be wondering how my lab began to probe the connection between SARS-CoV-2 and pain. We were inspired by two preliminary reports that appeared on the preprint server BioRxiv that showed that the infamous spike proteins on the surface of the SARS-CoV-2 virus bound to a protein called neuropilin-1. This means that the virus can also use this protein to invade nerve cells as well as through the ACE2 protein. For the past year, some six months before the pandemic took hold, my colleagues and I had been studying the role of neuropilin-1 in the context of pain perception. Because neuropilin-1, like the ACE2 receptor, allowed spike to enter the cells, we wondered if this alternate gateway could also be related to pain. Under normal circumstances, the neuropilin-1 protein controls the growth of blood vessels, and as well as the growth and survival of neurons. However, when neuropilin-1 binds to a naturally occurring protein called called Vascular endothelial growth factor A (VEGF-A), this triggers pain signals. This signal is transmitted via the spinal cord into higher brain centers to cause the sensation we all know as pain. Staring at this jigsaw puzzle – neuropilin-1 and VEGF-A and neuropilin and spike – we wondered if there was a link between spike and pain. Previous research has shown a link between VEGF-A and pain. For people with osteoarthritis, for instance, studies have shown that increased activity of the VEGF gene in fluids lubricating joints, like the knee, is associated with higher pain scores. Although activity of the neuropilin-1 gene is higher in biological samples from COVID-19 patients compared to healthy controls and activity of the neuropilin-1 gene is increased in pain-sensing neurons in an animal model of chronic pain, the role of neuropilin-1 in pain has never been explored until now. In in vitro studies done in my lab using nerve cells, we showed that when spike binds to neuropilin-1 it decreases pain signaling, which suggests that in a living animal it would also have a pain-dulling effect. When the spike protein binds to the neuropilin-1 protein, it blocks the VEGF-A protein from binding and thus hijack's a cell's pain circuitry. This binding suppresses the excitability of pain neurons, leading to lower sensitivity to pain.

Crystal structure of neuropilin-1 b1 domain (white surface with binding site in red) showing binding of VEGF-A (left), spike protein (middle), and the neuropilin-1 inhibitor EG00229 (right) (Dr Samantha Perez-Miller, CC BY-SA).

From the COVID-19 fog a new pain target emerges If our finding that the new coronavirus is attacking cells through a protein associated with pain and disabling the protein can be confirmed in humans, it may provide a new pathway for drug development to treat COVID-19. A small molecule, called EG00229, targeting neuropilin-1 had been reported in a 2018 study. This molecule binds to the same region of the neuropilin-1 protein as the viral spike protein and VEGF-A. So, I and my colleagues asked if this molecule was able to block pain. It did, during pain simulations in rats. Our data reaffirmed the notion of neuropilin-1 as a new player in pain signaling. There is precedence for targeting the neuropilin-1 protein for cancer treatment: for example, a Phase 1a clinical trial of an antibody called MNRP1685A (known under the product name Vesencumab) that recognizes and binds to neuropilin-1 and blocks VEGF-binding. This was mostly well tolerated in cancer patients, but it caused pain rather than blocking it.

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Our studies identify a different approach because we targeted blocking the pain-triggering VEGF-A protein, which then resulted in pain relief. So our preclinical work described here provides a rationale for targeting the VEGF-A/NRP-1 pro-pain signaling system in future clinical trials. Analysis of the structure of the neuropilin-1 receptor protein may allow design of drugs targeting this critical site which also controls axon growth, cell survival – in addition to pain relief. For instance, these neuropilin-1 receptor targeted drugs could potentially block viral infection. The testing of several candidate compounds, some of them on the FDA's generally regarded as safe list, is currently underway by my group. Sneaky virus, fooling people into believing that they do not have COVID-19. But, ironically, it may be gifting us with the knowledge of a new protein, critical for pain. Two roads emerge in the forest ahead: (1) block neuropilin-1 to limit SARS-CoV-2 entry, and (2) block neuropilin-1 to block pain.

Rajesh Khanna is Professor of Pharmacology @ University of Arizona.

First Compelling Evidence of Organisms That Eat Viruses as a Food Source Source: https://www.sciencealert.com/first-compelling-evidence-of-organisms-that-actually-eat-viruses-as-a-food-source

Sep 27 – Eat or be eaten: It's an edict of Mother Nature that connects every corner of the biosphere in a sprawling web of producers, consumers, detritivores, and scavengers. Every corner but one, it seems. Just what the hell dines on viruses? Scientists may have just discovered the answer.

Given the fact that the viral biomass dusting our landscape, drifting through the atmosphere, and floating in our oceans could easily add up to tens of millions of tonnes of carbon, there's a surprising absence of life making a meal of this bounty. If we're to be technical, there are viruses that have evolved to compete with other viruses by robbing them of their organic building blocks. But until now, there hasn't been any strong evidence of an organism engulfing and digesting virion particles for energy or their elemental nutrients. Two types of single-celled organisms found drifting in the waters of the Gulf of Maine off North America's coast just might be the first true virophages known to science. Researchers identified the virus grazers after sifting nearly 1,700 plankton cells collected from the waters of the gulf and the Mediterranean Sea, and amplifying the DNA inside each and every one to create individualised genomic libraries. Many of the sequences belonged to the organism itself, as would be expected.

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Around half of the libraries analysed from the Mediterranean sample contained sequences associated with bacteria likely to have been eaten by the plankton. For the samples pulled from the Gulf of Maine, that figure was more like 19 percent. Virus sequences were somewhat more common. In the gulf sample, half of the libraries contained snippets of genes from 50 or more different viruses. In the Mediterranean sample it was closer to a third of the sample. Most of the virus sequences appeared to be from bacteriophages – pathogens that invade and replicate inside bacterial cells. Bacteria are a common food source for marine protozoans, so finding their dinner came pre-infected isn't much of a surprise. But representatives belonging to groups known as choanozoans and picozoans, both collected from the waters off North America, stood out as a little unusual. For one thing, in many cases there was not a shred of bacterial DNA in sight. Without any signs of a bacterial brunch, it's hard to know how bacteriophage genes might have ended up inside the planktons' cells. More compelling still is that the two completely different phyla of protozoans shared near-identical viral sequences, making it hard to argue that infection was responsible. While the evidence for a diet of virus snacks could be considered circumstantial, it's not unlike finding dark crumbs dusting your toddler's fingers near an empty box of Oreos. Nobody's going to blame you for being suspicious. "Viruses are rich in phosphorus and nitrogen, and could potentially be a good supplement to a carbon-rich diet that might include cellular prey or carbon-rich marine colloids," says bioinformatics scientist Julia Brown from the Bigelow Laboratory for Ocean Sciences. For the picozoan, the discovery could help solve a mystery on what an insanely small organism barely a few micrometres in length dines on. Discovered a little more than a decade ago, researchers have been trying to figure out their place in the tree of life ever since. Given both types of protozoan are "cosmopolitan members of marine protist communities", a bacteriophage diet could have profound consequences for how we model the flow of nutrients through an ecosystem. Nutrients contained within bacteria and protozoans are expected to progress upwards through a food chain as tiny things get eaten by bigger ones. An obstacle in this process is referred to as the viral shunt. Infected by viruses, these cells can rupture before they're eaten, sending a snow of organic matter down through the depths. Far below on the ocean floor, this shunt accelerates, with viruses greedily churning through prokaryotes, preventing diverse food webs from establishing in the cold, inky darkness. Knowing that the tables have turned, and prokaryotes are biting back, could require some tweaking in the numbers that describe how this process takes place. "The removal of viruses from the water may reduce the number of viruses available to infect other organisms, while also shuttling the organic carbon within virus particles higher up the food chain," says Brown.

 This research was published in Frontiers in Microbiology.

ECCVID 2020 – High prevalence of fatigue following SARS-CoV-2 infection independent of COVID-19 severity Source: https://www.univadis.com/viewarticle/eccvid-2020-high-prevalence-of-fatigue-following-sars-cov-2-infection-independent- of-covid-19-severity-e9322181-e1f0-3904-8329-da14d0d4d31b

Sep 23 – Research presented at the 2020 ESCMID Conference on Coronavirus Disease (ECCVID), held online from 23-25 September, shows that persistent fatigue occurs in more than half of patients recovered from COVID-19, regardless of the seriousness of their infection. “Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. Whilst the presenting features of SARS- CoV-2 infection have been well-characterised, the medium and long-term consequences of infection remain unexplored,” explained study lead author Dr Liam Townsend, St James’s Hospital and Trinity Translational Medicine Institute, Trinity College, Dublin, Ireland. The study used a commonly-used scale to determine fatigue in recovered patients, called the Chalder Fatigue Score (CFQ-11). They also looked at the severity of the patient’s initial infection (need for admission, and critical/intensive care), their pre-existing conditions including depression, and various markers of immune activation (white cell counts, C- reactive protein, Interluekin-6, and sCD25).

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The study included 128 participants (mean age 50 years; 54% female) who were recruited consecutively at a median of 10 weeks following clinical recovery from SARS-CoV-2 infection. More than half reported persistent fatigue (52.3%; 67/128) at this point. Of the patients assessed in this study, 71/128 (55.5%) were admitted to hospital and 57/128 (44.5%) were not admitted. “Fatigue was found to occur independent of admission to hospital, affecting both groups equally,” explained Dr Townsend. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (white blood cell counts or ratios, lactate dehydrogenase, C-reactive protein) or pro-inflammatory molecules (IL-6 or sCD25) and fatigue post COVID-19. Female gender and those with a pre-existing diagnosis of depression/anxiety were over-represented in those with fatigue. Although women represented just over half of the patients in the study (54%), two-thirds of those with persistent fatigue (67%) were women.

Severe COVID-19 Cases Linked to Genes, Autoimmunity, and Interferon Disruption Source: https://www.genengnews.com/news/severe-covid-19-cases-linked-to-genes-autoimmunity-and-interferon-disruption/

Sep 28 – Why a SARS-CoV-2 infection is asymptomatic in some people and deadly in others is a mystery that has been at the forefront of researchers’ minds for the last six months. The Casanova lab at the Rockefeller University has been studying this same question, with other pathogens, for years. In January, the lab turned their attention to COVID-19. And now, in collaboration with colleagues, they have published two papers that shed significant insight into why there is such immense clinical variability between individuals. The findings also may provide the first molecular explanation for why more men than women die from COVID-19. The work is published in back-to-back Science papers. The first paper is titled, “Inborn errors of type I IFN immunity in patients with life-threatening COVID-19,” and the second, “Auto-antibodies against type I IFNs in patients with life-threatening COVID-19.” Since February 2020, Helen Su, MD, PhD, a senior investigator at the National Institute of Allergy and Infectious Diseases (NIAID), part of the NIH; and Jean-Laurent Casanova, MD, PhD, head of the St. Giles Laboratory of Human Genetics of Infectious Diseases at the Rockefeller University, and their collaborators, have enrolled thousands of COVID-19 patients to find out whether a genetic factor drives these disparate clinical outcomes. The researchers, led by Qian Zhang, MD, a research associate in the Casanova lab, discovered that among nearly 660 people with severe COVID-19, a significant number carried rare genetic variants in 13 genes known to be critical in the body’s defense against influenza virus, and more than 3.5% were completely missing a functioning gene. Further experiments showed that immune cells from those 3.5% did not produce any detectable type I interferons in response to SARS-CoV-2. Specifically, they found an enrichment in rare variants predicted to be loss-of- function (LOF) at the 13 human loci known to govern TLR3- and IRF7- dependent type I interferon (IFN) immunity to influenza virus, in 659 patients with life-threatening COVID-19 pneumonia, relative to 534 subjects with asymptomatic or benign infection. The authors showed that human fibroblasts with mutations affecting this pathway are vulnerable to SARS-CoV-2. Examining nearly 1,000 patients with life-threatening COVID-19 pneumonia, the researchers also found that more than 10% had autoantibodies against interferons at the onset of their infection, and 95% of those patients were men. The 101 patients had “neutralizing IgG auto-Abs against IFN-ω (13 patients), the 13 types of IFN-α (36), or both (52), at the onset of critical disease; a few also had auto-Abs against the other three type I IFNs.” The auto-antibodies neutralize the ability of type I IFNs to block SARS-CoV-2 infection in vitro. In addition, the authors noted that these auto-Abs were not found in 663 individuals with asymptomatic or mild SARS-CoV-2 infection and were present in only four of 1,227 healthy individuals. Consequently, both groups lack effective immune responses that depend on type I interferon, a set of 17 proteins crucial for protecting cells and the body from viruses. Whether these proteins have been neutralized by autoantibodies or for a genetic reason were produced in insufficient amounts or induced an inadequate antiviral response, their absence appears to be a

www.cbrne-terrorism-newsletter.com 90 HZS C2BRNE DIARY – October 2020 commonality among a subgroup of people who suffer from life-threatening COVID-19 pneumonia. These findings are the first published results from the COVID Human Genetic Effort, an international project spanning more than 50 genetic sequencing hubs and hundreds of hospitals.

Pets Can Be a Mental Health Buffer During the Stress of Lockdown, Study Shows Source: https://www.sciencealert.com/a-pet-can-act-as-a-mental-health-buffer-during-lockdown-survey-finds

Sep 29 – Good news for pet owners, and not just dog people and cat lovers. Having a pet or companion animal – whether it be a furry friend or farm animal – seems to help people's mental health cope with the stresses caused by pandemic life and loneliness during lockdown. According to a study from the UK, pets were an important source of emotional support for many people during lockdown, reducing the loneliness they reportedly felt and improving their general mental health. "This work is particularly important at the current time as it indicates how having a companion animal in your home can buffer against some of the psychological stress associated with lockdown," said animal behaviour researcher Daniel Mills from the University of Lincoln. We know that loneliness is linked to higher risk of developing other mental health problems, such as depression and anxiety. And from previous research, we are starting to recognise that pets can seriously support people living with severe mental illness, such as bipolar disorder and schizophrenia. This study, however, involved surveying people of all walks of life, and under largely unprecedented circumstances – a pandemic lockdown. Between mid-April and the end of May, close to 6,000 people living in the UK during lockdown were surveyed about their mental health and their pets. Most of the study participants had at least one pet, so although the researchers surveyed thousands of people, only a small fraction of people involved didn't own any pets, meaning the findings are skewed towards animal lovers. "Results need to be interpreted with this caveat in mind," the authors explain in their paper. "Nonetheless, in our sample of 'animal lovers', having an animal was linked to somewhat attenuated effects of the lockdown experience on mental health and loneliness." People who responded to the survey were asked questions about how close they felt to their pet and the comfort their animal friend provided, as well as different ways their pets might have positively affected their wellbeing during lockdown. This could be helping their owners stay active or feeling socially connected to other people. Participants also assessed their own mental health wellbeing and feelings of loneliness by answering questionnaires about how they felt before and during the UK lockdown. Analysing the data, the researchers adjusted for other things that may affect a person's mental health: such as how lonely the person was before lockdown; their age; if they lived

www.cbrne-terrorism-newsletter.com 91 HZS C2BRNE DIARY – October 2020 alone or with other people; and how many social contacts (with human friends) they had each week. The vast majority of pet owners (including more than 90 percent of dog, horse, and cat owners) said their animals had helped them cope emotionally with the lockdown, and had positive effects on their family as well. People with pets were still affected by the lockdown, but owning an animal was associated with smaller declines in mental health and smaller increases in loneliness than what was reported by people who didn't own pets. The results are similar to findings from before the pandemic, including, for example, that pets can stave off loneliness by encouraging more social interactions. Most studies like this to date have focused on dogs and cats, but it turns out, unsurprisingly, that people can form strong emotional connections with any type of pet; it doesn't depend on which species we choose as our companion. Once the researchers had accounted for whether people's pets had a special role in their lives, such as an assistance dog or therapy animal (which can dramatically improve someone's mental health), there was no significant difference between the emotional bonds people formed with their pets. "People in our sample felt on average as emotionally close to, for example, their guinea pig as they felt to their dog," said lead author and mental health researcher Elena Ratschen from the University of York. So don't discount unlikely pets: remember goats can be as loving as dogs. The study also found potential links between people's mental health and the emotional bonds they form with their pets. People who reported a stronger bond with their pet in the study tended to report poorer mental health to begin with, which might mean they're somewhat vulnerable to fluctuations in their mental health, and possibly reliant on their pet for support. "Interestingly, stronger reported human-animal bonds were associated with poorer mental health pre-lock down, highlighting that close bonds with animals may indicate psychological vulnerability in owners," the authors said. But having a pet also sometimes added to stresses during lockdown, the study found, in addition to mitigating stress. Over two-thirds of pet owners reported worrying about their pets during lockdown. Some people in the survey worried about who would look after their pet if they fell ill. Other owners were concerned that their animal friend might not cope so well when they returned to work after lockdown. It's also important to note that while lockdown may have been a little less lonely for pet owners, the overall differences in mental health as reported by animal owners and pet-free people were small. This means we can't make any grand conclusions that getting a pet would necessarily solve all our worries. "While our study showed that having a pet may mitigate some of the detrimental psychological effects of the COVID-19 lockdown, it is important to understand that this finding is unlikely to be of clinical significance," Ratschen and her colleagues noted. This means the changes to people's mental health recorded in the study were not so profound that we should go recommending it as a cure-all to other people. "[It] does not warrant any suggestion that people should acquire pets to protect their mental health during the pandemic," said Ratschen. Nonetheless, there has been a huge surge in demand to adopt pets during the pandemic, from New York to Sydney, and there are concerns that many of these animals might be abandoned when people return to school and work, or if they can no longer afford to take care of them. So, remember to look out for your animal friends, just like they look out for us.

 The study was published in PLOS One.

EDITOR’S COMMENT: “Lockdown depression” resembles the “retirement depression”. If the individual has no interests beyond his/her job then it is very difficult to cope with plenty of free time without something creative to do or without a program to follow. In that respect, it is not wise to be absorbed by your current jobs without exploring other interests, hobbies or activities. Do it now before it is too late!

Conversation quickly spreads droplets inside buildings Source [video]: https://www.eurekalert.org/pub_releases/2020-09/pues-cqs092820.php

Sep 29 – With implications for the transmission of diseases like COVID-19, researchers have found that ordinary conversation creates a conical 'jet-like' airflow that quickly carries a spray of tiny droplets from a speaker's mouth across meters of an interior space.

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"People should recognize that they have an effect around them," said Howard Stone, the Donald R. Dixon '69 and Elizabeth W. Dixon Professor of Mechanical and Aerospace Engineering at Princeton University. "It's not just around your head, it is at the scale of meters." Although scientists have not yet fully identified the transmission mechanisms of COVID-19, current research indicates that people without symptoms could infect others through tiny droplets created when they speak, sing or laugh. Stone and co-lead researcher

Manouk Abkarian, of the University of Montpellier in France, wanted to learn how widely and quickly exhaled material from an average speaker could spread in an interior space. "Lots of people have written about coughs and sneezes and the kinds of things you worry about with the flu," Stone said. "But those features are associated with visible symptoms, and with this disease we are seeing a lot of spread by people without symptoms." In an article published Sept. 25 in the Proceedings of the National Academy of Sciences, the researchers concluded that for interior activities, normal conversations can spread exhaled material at least far as, if not beyond, social distancing guidelines recommended by the World Health Authority (1 meter) and U.S. officials (2 meters.) The work examined particle flow in an interior space without good ventilation. Stone and Abkarian stressed that they are not public health experts and are not making medical recommendations. However, they said public health officials should consider the aerodynamic movement of aerosolized particles generated by speech alone already as an important factor for directed spreading. "It certainly highlights the importance of ventilation," Stone said. "Especially if you have an extended conversation." The researchers also said that while masks do not completely block the flow of aerosols, they play a critical role in disruption of the 'jet-like' air flow from a speaker's mouth, preventing the quick transport of droplets on large length scales bigger than 30 cm. "Masks really cut this flow of tremendously," Stone said. "This identifies why (most) masks play a big role. They cut everything off." The researchers specialize in fluid dynamics, which describes the movement of liquids and gasses. Using a high-speed camera, they film the movement of a mist of tiny droplets illuminated by a laser sheet in front of a person speaking several different phrases adjacent to the sheet. The phrases ranged from short statements like "we will beat the corona virus" to nursery rhymes including "Peter Piper picked a peck" and "Sing a song of six pence." The researchers selected the phrases to include different sounds that affect turbulent flows in a speaker's exhalation.

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The researchers found that plosive sounds like 'P' create puffs of air in front of the speaker while a conversation created what the researchers called a "train of puffs." Each puff creates a small vortex of air in front of the speaker, and the interaction of these vortices creates a cone-shaped 'jet-like' airflow from the speaker's mouth. The researchers found that this airflow could easily and very quickly carry tiny particles away from the speaker. Abkarian said that even a short phrase can move the particles past the 1-meter distancing recommended by the World Health Organization in a matter of seconds. The researchers said the distance depends in part on the duration of the conversation. Someone speaking for more time will send particles farther. They said that the 6-foot distancing rule may not be a sufficient barrier in an interior space without good ventilation. "If you speak for 30 seconds in a loud voice, you are going to project aerosol more than six feet in the direction of your interlocutor," Stone said. In the paper, the researchers found that aerosols ejected during speech typically reached the 2-meter distance in about 30 seconds, and over that distance the aerosols' concentration diluted to about 3 percent of the original volume. It was beyond the paper's scope to say whether the dilution was sufficient to protect against infection, although the researchers noted that many will find this concentration to be higher than expected. The researchers said they hoped the information could help public health officials to make that determination. They also noted that longer conversations had the potential to spread more material and spread the virus over a larger distance. "However, more extended discussions, and meetings in confined spaces, mean that the local environment will potentially contain exhaled air over a significantly longer distance," the researchers wrote. The researchers said the experiment showed that a social distance of 6 feet (2 meters) did not work like a wall to protect people. Over time, conversations can cause material to move past the distance, particularly inside buildings. The train of puffs created by a conversation causes a more complex turbulent flow than single jets of air and researchers had to account for it in their calculations. The researchers used the data from the experiments to create a mathematical framework to quantify the transport of droplets from the speaker's mouth to the surrounding area. They noted that the work does not account for movement of the speaker's head or body and background air movement caused by ventilation and other speakers. Analyzing those factors would require further work.

The Covid-19 Numbers Game: The “Second Wave” is Based on Fake Statistics [Sep 28] Source: https://www.globalresearch.ca/the-covid-19-numbers-game-the-second-wave-is-based-on-fake-statistics/5725003  NOTE: Special focus on “PCR” at the end of the web page.

Specific T Cells Activated in Severe COVID-19 Cases Source: https://www.genengnews.com/news/specific-t-cells-activated-in-severe-covid-19-cases/

Sep 29 – In order to develop new treatments for COVID-19, it is important to understand how the human immune system responds to a SARS-CoV-2 infection. Now, a team from the Karolinska Institutet in Sweden has found that a type of unconventional T cell, mucosa-associated invariant T (MAIT) cells, are recruited to the airways and strongly activated in some patients with severe COVID-19, suggesting the cells’ possible involvement in the development of disease. These findings corroborate other recent studies that highlight potential associations between strong MAIT cell activation and severe COVID-19 outcomes. The research is published in Science Immunology in an article titled, “MAIT cell activation and dynamics associated with COVID-19 disease severity.” Severe COVID-19 is characterized by excessive inflammation of the lower airways. The balance of protective versus pathological immune responses in COVID-19 is not well understood. MAIT cells are antimicrobial T cells that can function as innate-like sensors and mediators of antiviral responses. MAIT cells represent 1–10% of T cells in the blood and can readily home into specific tissues—they are found in particularly abundant amounts in the liver and lungs. Emerging evidence has shown these primarily antibacterial cells can also act as quick-

www.cbrne-terrorism-newsletter.com 94 HZS C2BRNE DIARY – October 2020 acting sensors of viral infection as well, leading researchers to investigate the MAIT cell population in the context of SARS-CoV-2. In this study, the researchers wanted to find out which role MAIT cells play in COVID-19 disease pathogenesis. They examined the presence and character of MAIT cells in blood samples from 24 patients admitted to Karolinska University Hospital with moderate to severe COVID-19 disease and compared these with blood samples from 14 healthy controls and 45 individuals who had recovered from COVID-19. Four of the patients died in the hospital. The results show that the number of MAIT cells in the blood decline sharply in patients with moderate or severe COVID-19 and that the remaining cells in circulation are highly activated, which suggests they are engaged in the immune response against SARS-CoV-2. This pattern of reduced number and activation in the blood is stronger for MAIT cells than for other T cells. The researchers also noted that pro- inflammatory MAIT cells accumulated in the airways of COVID-19 patients to a larger degree than in healthy people. “Taken together, these analyses indicate that the reduced number of MAIT cells in the blood of COVID-19 patients is at least partly due to increased accumulation in the airways,” Johan Sandberg, PhD, professor and group leader at the Karolinska Institutet, said. Together, these patterns are consistent with the concept that MAIT cells home into tissues during disease and later return into the blood when the disease is resolved. Furthermore, transcriptomic analyses indicated significant MAIT cell enrichment and pro- inflammatory IL-17A bias in the airways. Unsupervised analysis identified MAIT cell CD69high and CXCR3low immunotypes associated with poor clinical outcome. Four out of 24 patients studied here who died at the hospital had significantly higher CD69 expression by MAIT cells than patients who survived. The authors noted several limitations of their study that must be resolved with further work, including that the cohorts studied here do not reflect the full complexity of COVID-19.

OB/GYN Resident on ECMO for COVID-19 Dies at 28 Source: https://www.medscape.com/viewarticle/937958

Sep 24 – Adeline Fagan, 28, a second-year obstetrics/gynecology resident in a Houston hospital, died last week, 2 months after contracting COVID-19, her family reported. The family posted on a GoFundMe page set up in her honor that, although she mostly delivered babies, Fagan was doing a rotation in the emergency department treating patients with COVID-19. According to Fagan's family, flu-like symptoms began July 8 and within a week she was diagnosed with COVID-19 and hospitalized. She was given several respiratory therapies and medications, with no response. She was placed on extracorporeal membrane oxygenation (ECMO) on August 4. Her father, Brant Fagan, posted on social media that on the evening of September 18 the family had called Adeline's hospital and gotten a good report, but half an hour later they got the news that a routine check had found she was unresponsive and it was discovered she had had a massive brain bleed. The family had to decide about a risky procedure to relieve the pressure.

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"The neurosurgeon said it was a '1 in a million' chance she would even survive the procedure, but that Adeline would have several severe cognitive and sensory limitations if she did survive," Brant Fagan wrote. Adeline's parents were able to be with her that night. "We spent the remaining minutes hugging, comforting and talking to Adeline. And then the world stopped," her father wrote. Adeline's sister Maureen said in an interview with CNN, "Adeline did pass away in my mom and dad's arms." It's often associated with a high risk for death, and when patients do survive "they survive with significant neurological defects," he said. Katz explained the choice: Patients are put on ECMO because "you don't think they can live without it," so providers trade a small risk for hemorrhages for a chance at life. Although he did not know the particulars of Adeline's case, Katz said, "A 28-year-old vibrant young woman — who for whatever reason develops a severe COVID-19 ARDS (acute respiratory distress syndrome) — she's the exact person you'd want to use this type of technology on. "That's the type of patient you go to the ends of the Earth for," he said. COVID-19 deaths are much more prevalent in people older than Adeline Fagan. As of September 16, 2020, 1405 people ages 25 to 34 have died from COVID-19, of the more than 200,000 deaths nationwide, according to the Centers for Disease Control and Prevention. According to CBS affiliate KHOU, Adeline's sisters said she had a history of asthma, upper respiratory infections, and pneumonia, but that did not keep her from the work she loved even during the pandemic. Maureen told the TV station in August, "It's what she wants to be doing. She wants to get out of bed every morning and deliver babies and help women." Adeline in Haiti (2017)

Another of Adeline's three sisters, Natalie Fagan, told KHOU that "from the beginning of time her sister wanted to be a doctor." "She fought for it," Natalie Fagan said. "She fought hard. She studied hard. She studied really hard and she got there."

"A Little of Ourselves in Adeline" Jesse O'Shea, MD, an infectious disease physician at Emory University School of Medicine in Atlanta, Georgia, told Medscape Medical News that he met Adeline, a Syracuse-area native, through a mutual friend 4 years ago when she was a medical student at the University of Buffalo's Jacobs School of Medicine and Biomedical Sciences in New York. "Every one of us in the medical community sees a little of ourselves in Adeline," he said. "We are on the front lines treating patients and we know there's some risk of catching it ourselves. For this to happen to someone my age reveals this vulnerability we all have to the virus," O'Shea said. "To know the struggle that her family had gone through and her friends and the community, over the last couple of months and to have this outcome, it just tore me apart," he said. According to the University of Buffalo, Adeline participated in four global medicine outreach trips to Haiti during medical school.

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A medical school classmate said as part of the university's remembrance, "No matter how hard things were, she came in ready and with a smile on. After our first trip in Haiti, we came back and she had contracted chikungunya." The classmate added, "She hobbled around in pain for weeks, but was not deterred in the least. Instead, she kept talking about how much she loved the trip and wanted to go back (and she did three times, more than any other student in our class)." According to the university's tribute, David Holmes, MD, clinical associate professor of family medicine and director of the Jacobs School of Medicine and Biomedical Sciences' Global Health Education Program, remembered Fagan as "a wonderful person who really cared about people and the world." The family made a final request on its GoFundMe page: "If you can do one thing, be an 'Adeline' in the world. Be passionate about helping others less fortunate, have a smile on your face, a laugh in your heart, and a Disney tune on your lips."

Hemorrhages "Most Feared" Complication of ECMO Jeffrey Katz, MD, director of critical care services at the NorthShore University HealthSystem in Evanston, Illinois, told Medscape Medical News that intracranial hemorrhages associated with ECMO are uncommon, but "are probably the most feared complications of ECMO." Research has shown a risk rate of 3% to 4% on the heart-support ECMO, he said. "It's unclear what the risk is on the respiratory support ECMO," he said, "but we postulate that it's probably less." Any patient on ECMO, Katz said, needs relatively high levels of anticoagulation and that is a risk for intracranial hemorrhages. "There have been case reports about patients with COVID having this hemorrhage complication on ECMO," Katz said. The two main causes are thought to be the high doses of anticoagulation and that COVID causes inflammation of the blood vessels. The combination can lead to intracranial hemorrhaging, Katz said.

COVID-19: Innovative PPE Respirator Developed for ICU Staff Source: https://www.medscape.com/viewarticle/937641

Sep 18 – Researchers have designed a new type of personal protective equipment (PPE) respirator for improving the safety of health care professionals during the COVID-19 pandemic. The Bubble PAPR, a powered air-purifying respirator (PAPR), is developed by the intensive care unit (ICU) staff at Wythenshawe Hospital within the Manchester University NHS Foundation Trust. The inexpensive device comprises a reusable collar that sits around the neck and a single-use recyclable plastic hood. A built-in fan in the collar draws in air through a virus filter and delivers a cooling airflow around the wearer's face.

Image Credit: University of Manchester/ Manchester University NHS Foundation Trust

The respirator has been designed to comply with rigorous infection control practices and be comfortable to wear throughout the shift duration in the ICU, or other high-risk areas. Additionally, the wearer’s face is clearly visible through the transparent hood, which does not hamper communication between staff and substantially improves the patient experience. The device has been tested in a simulated clinical setting and has received positive responses from the staff. A patent has been filed for the respirator, and the team is now coordinating with manufacturing and distribution partners to have it widely available for front-line staff before the end of 2020. Dr Glen Cooper, from the University of Manchester, said: "The Bubble PAPR is both ergonomically and mechanically the right product to meet the need to protect NHS staff during the COVID crisis and beyond."

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How Coronavirus Took Hold in North America and Europe By Daniel Stolte Source: http://www.homelandsecuritynewswire.com/dr20200929-how-coronavirus-took-hold-in-north-america-and-europe

Sep 29 – A new study combines evolutionary genomics from coronavirus samples with computer-simulated epidemics and detailed travel records to reconstruct the spread of coronavirus across the world in unprecedented detail. Published in the journal Science, the results suggest an extended period of missed opportunity when intensive testing and contact tracing might have prevented SARS-CoV-2 from becoming established in North America and Europe. The paper also challenges suggestions that linked the earliest known cases of COVID-19 on each continent in January to outbreaks detected weeks later, and provides valuable insights that could inform public health response and help with anticipating and preventing future outbreaks of COVID-19 and other zoonotic diseases. “Our aspiration was to develop and apply powerful new technology to conduct a definitive analysis of how the pandemic unfolded in space and time, across the globe,” said University of Arizona researcher Michael Worobey, who led an interdisciplinary team of scientists from 13 research institutions in the U.S., Belgium, Canada and the U.K.“Before, there were lots of possibilities floating around in a mishmash of science, social media and an unprecedented number of preprint publications still awaiting peer review.” The team based their analysis on results from viral genome sequencing efforts, which began immediately after the virus was identified and quickly grew into a worldwide effort, unprecedented in scale and pace, that has yielded tens of thousands of genome sequences, publicly available in databases. Contrary to widespread narratives, the first documented arrivals of infected individuals traveling from China to the U.S. and Europe did not snowball into continental outbreaks, the researchers found. Instead, swift and decisive measures aimed at tracing and containing those initial incursions of the virus were successful and should serve as model responses directing future actions and policies by governments and public health agencies, the study’s authors conclude.

How the Virus Arrived in the U.S. and Europe A Chinese national flying into Seattle from Wuhan, China on Jan. 15 became the first patient in the U.S. shown to be infected with the novel coronavirus and the first to have a SARS-CoV-2 genome sequenced. This patient was designated “WA1.” It was not until six weeks later that several additional cases were detected in Washington state. “And while all that time goes past, everyone is in the dark and wondering, ‘What’s happening?’” said Worobey, head of the UArizona Department of Ecology and Evolutionary Biology and a member of university’s BIO5 Institute. “We hope we’re OK, we hope there are no other cases, and then it becomes clear, from a remarkable community viral sampling program in Seattle, that there are more cases in Washington and they are genetically very similar to WA1’s virus.” Worobey and his collaborators tested the prevailing hypothesis suggesting that patient WA1 had established a transmission cluster that went undetected for six weeks. Although the genomes sampled in February and March share similarities with WA1, they are different enough that the idea of WA1 establishing the ensuing outbreak is very unlikely, they determined. The researchers’ findings indicate that the jump from China to the U.S. likely occurred on or around Feb. 1 instead. The results also put to rest speculation that the Washington outbreak – the earliest substantial transmission cluster in the U.S. – may have been initiated indirectly by dispersal of the virus from China to British Columbia, Canada, just north of Washington State, and then spread from Canada to the U.S. Multiple SARS-CoV-2 genomes published by the British Columbia Center for Disease Control appeared to be ancestral to the viral variants sampled in Washington state, strongly suggesting a Canadian origin of the U.S. epidemic. However, the present study revealed sequencing errors in those genomes, thus ruling out that scenario. Instead, the new study implicates a direct-from-China source of the U.S. outbreak, right around the time the U.S. administration implemented a travel ban for travelers from China in early February. The nationality of the “index case” of the U.S. outbreak cannot be known for certain because tens of thousands of U.S. citizens and visa holders traveled from China to the U.S. even after the ban took effect. A similar scenario marks the first known introduction of coronavirus into Europe. On Jan. 20, an employee of an automotive supply company in Bavaria, Germany, flew in for a business meeting from Shanghai, China, unknowingly carrying the virus and ultimately leading to infection of 16 co-workers. In that case, too, an impressive response of rapid testing and isolation prevented the outbreak from spreading any further, the study

www.cbrne-terrorism-newsletter.com 98 HZS C2BRNE DIARY – October 2020 concludes. Contrary to speculation, this German outbreak was not the source of the outbreak in Northern Italy that eventually spread widely across Europe and eventually to New York City and the rest of the U.S. The authors also show that this China-to-Italy-to-U.S. dispersal route ignited transmission clusters on the East Coast slightly later in February than the China-to-U.S. movement of the virus that established the Washington state outbreak. The Washington transmission cluster also predated small clusters of community transmission in February in California, making it the earliest anywhere in North America.

Early Containment Works The authors say intensive interventions, involving testing, contact tracing, isolation measures and a high degree of compliance of infected individuals – who reported their symptoms to health authorities and self-isolated in a timely manner – helped Germany and the Seattle area contain those outbreaks in January. “We believe that those measures resulted in a situation where the first sparks could successfully be stamped out, preventing further spread into the community,” Worobey said. “What this tells us is that the measures taken in those cases are highly effective and should serve as a blueprint for future responses to emerging diseases that have the potential to escalate into worldwide pandemics.” To reconstruct the pandemic’s unfolding, the scientists ran computer programs that carefully simulated the epidemiology and evolution of the virus – in other words, how SARS-CoV-2 spread and mutated over time. “This allowed us to rerun the tape of how the epidemic unfolded, over and over again, and then check the scenarios that emerge in the simulations against the patterns we see in reality,” Worobey said. “In the Washington case, we can ask, ‘What if that patient WA,1 who arrived in the U.S. on Jan. 15, really did start that outbreak?’ Well, if he did, and you re-run that epidemic over and over and over and then sample infected patients from that epidemic and evolve the virus in that way, do you get a pattern that looks like what we see in reality? And the answer was no,” he said. “If you seed that early Italian outbreak with the one in Germany, do you see the pattern that you get in the evolutionary data? And the answer, again, is no,” he said. “By re-running the introduction of SARS-CoV-2 into the U.S. and Europe through simulations, we showed that it was very unlikely that the first documented viral introductions into these locales led to productive transmission clusters,” said study co-author Joel Wertheim of the University of California, San Diego. “Molecular epidemiological analyses are incredibly powerful for revealing transmissions patterns of SARS-CoV-2.” Other methods were then combined with the data from the virtual epidemics, yielding exceptionally detailed and quantitative results. “Fundamental to this work stands our new tool combining detailed travel history information and phylogenetics, which produces a sort of ‘family tree’ of how the different genomes of virus sampled from infected individuals are related to each other,” said co-author Marc Suchard of the University of California, Los Angeles. “Our research shows that when you do early intervention and detection well, it can have a massive impact, both on preventing pandemics and controlling them once they progress,” Worobey said. “While the epidemic eventually slipped through, there were early victories that show us the way forward: Comprehensive testing and case identification are powerful weapons.”

Daniel Stolte is the senior science writer for the University of Arizona Office of Marketing & Communication.

Indian biological weapons expert says covid-19 is “bioterrorism” Source: https://www.naturalnews.com/2020-09-29-indian-biological-weapons-expert-says-covid-19-is-bioterrorism.html

Sep 29 – A police officer in India who also claims to be a biological weapons expert has written a new book suggesting that the Wuhan coronavirus (covid-19) is a product of bioterrorism. Dr. Sharad S. Chauhan, a decorated Indian Police Service (IPS) officer, contends in his book COVID-19 – Opportunistic Bioterrorism? A Virus from China set to Change World History that experiments taking place on SARS- like coronaviruses in communist China are what led to the Wuhan coronavirus (covid-19) being unleashed. For more than a decade, Chinese researchers have been tampering with coronavirus, Chauhan suggests in his book. Then, when China’s economy was in shambles, the novel virus suddenly emerged for the first time in an act of opportunistic bioterrorism, he insists. “What started as an outbreak in China near the end of 2019 is now a global calamity,” reports Great Game India, a Journal on Geopolitics & International Relations.

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“The rampaging COVID-19 pandemic has changed the world as never before, the great wars and pandemics of past included. The strategic, geopolitical and geo-economics consequences of COVID-19 are slowly unfolding. The virus from China is set to change the world.” More related news about the Wuhan coronavirus (covid-19) is available at Pandemic.news.

Opportunistic Bioterrorism includes 101 critical questions about covid-19 Chauhan’s book relies on both scientific and open source intelligence to scrutinize the evidence surrounding the Chinese laboratory origins of the Wuhan coronavirus (covid-19). It also draws from Chauhan’s own expertise while in medical school and in the Indian police force. His book also raises what Great Game India says are 101 “critical questions” about the Wuhan coronavirus (covid-19) that deserve answers. While the issue of its origins in a Chinese laboratory were kept out of the main text and put into an Appendix, other issues are brought forth in the body that are worthy of consideration. “The questionnaire appended is a judicious mix of both clarifying and probing questions and valuable in and of itself, irrespective of the answer to facilitate effective deliberation on the topic,” the journal reports. “The book is a single source reference for all contentious issues relating to the COVID-19 pandemic,” it adds.

Does Dr. Li-Meng Yan’s account of events suffice as evidence of bioterrorism? Another person spreading the bioterrorism narrative is Dr. Li-Meng Yan, who we reported has come forward as a type of whistleblower with claims that the Wuhan coronavirus (covid-19) is, in fact, a bioweapon. Dr. Li-Meng has appeared on Fox News and elsewhere to suggest that the novel virus “came from a Chinese Communist Party (CCP) military lab.” She has further suggested that the Wuhan wet market narrative “was just used as a decoy.” Some have questioned the legitimacy of Dr. Li-Meng’s claims, while others believe her to be telling the truth. She is currently not in communist China, despite having lived there prior to coming forward with these alleged revelations. Further claims made by Dr. Li-Meng include the allegation that she tried to go to her superiors about what she discovered concerning the virus, only to be turned away and ignored. She also expressed concerns that she might “disappear at any time” for raising questions, though she is still on the media circuit today. One thing is for sure: The Wuhan coronavirus (covid-19) is not a natural occurrence, nor did it somehow spontaneously appear without goading from “science.” With that said, it is safe to assume that there is at least some truth to the claims made that the novel virus is a Chinese bioweapon, if not a Chinese psychological weapon that was designed to inflict maximum terror on the masses. “This is so worrying,” wrote one Twitter user in response to a Great Game India tweet from back in March that was among the first to expose the Wuhan coronavirus (covid-19) as a potential bioweapon. “If it’s true, then @WHO officials are definitely hand in glove with #China.”

One number could help reveal how infectious a COVID-19 patient is. Should test results include it? Source: https://www.sciencemag.org/news/2020/09/one-number-could-help-reveal-how-infectious-covid-19-patient-should-test-results

Sep 29 – Ever since the coronavirus pandemic began, battles have raged over testing: Which tests should be given, to whom, and how often? Now, epidemiologists and public health experts are opening a new debate. They say testing centers should report not just whether a person is positive, but also a number known as the cycle threshold (CT) value, which indicates how much virus an infected person harbors. Advocates point to new research indicating that CT values could help doctors flag patients at high risk for serious disease. Recent findings also suggest the numbers could help officials determine who is infectious and should therefore be isolated and have their contacts tracked down. CT value is an imperfect measure, advocates concede. But whether to add it to test

www.cbrne-terrorism-newsletter.com 100 HZS C2BRNE DIARY – October 2020 results “is one of the most pressing questions out there,” says Michael Mina, a physician and epidemiologist at Harvard University’s T.H. Chan School of Public Health Standard tests identify SARS-CoV-2 infections by isolating and amplifying viral RNA using a procedure known as the polymerase chain reaction (PCR), which relies on multiple cycles of amplification to produce a detectable amount of RNA. The CT value is the number of cycles necessary to spot the virus; PCR machines stop running at that point. If a positive signal isn’t seen after 37 to 40 cycles, the test is negative. But samples that turn out positive can start out with vastly different amounts of virus, for which the CT value provides an inverse measure. A test that registers a positive result after 12 rounds, for a CT value of 12, starts out with more than 10 million times as much viral genetic material as a sample with a CT value of 35. But the same sample can give different CT values on different testing machines, and different swabs from the same person can give different results. “The CT value isn’t an absolute scale,” says Marta Gaglia, a virologist at Tufts University. That makes many clinicians wary, Mina says. “Clinicians are cautious by nature,” Mina says. “They say, ‘If we can’t rely on it, it’s not reliable.’” In an August letter in Clinical Infectious Diseases, members of the College of American Pathologists urged caution in interpreting CT values. Nevertheless, Mina, Gaglia, and others argue that knowing whether CT values are high or low can be highly informative. “Even with all the imperfections, knowing the viral load can be extremely powerful,” Mina says. Early studies showed that patients in the first days of infection have CT values below 30, and often below 20, indicating a high level of virus; as the body clears the coronavirus, CT values rise gradually. More recent studies have shown that a higher viral load can profoundly impact a person’s contagiousness and reflect the severity of disease. In a study published this week in Clinical Infectious Diseases, researchers led by Bernard La Scola, an infectious diseases expert at IHU-Méditerranée Infection, examined 3790 positive samples with known CT values to see whether they harbored viable virus, indicating the patients were likely infectious. La Scola and his colleagues found that 70% of samples with CT values of 25 or below could be cultured, compared with less than 3% of the cases with CT values above 35. “It’s fair to say that having a higher viral load is associated with being more infectious,” says Monica Gandhi, an infectious diseases specialist at the University of California, San Francisco. Conversely, people often test positive for weeks or even months after they recover but have high CT values, suggesting the PCR has identified genetic material from noninfectious viral debris. Current guidelines from the Centers for Disease Control and Prevention and World Health Organization, which call for patients to isolate themselves for 10 days after onset of symptoms, recognize they are not likely to be infectious after that period. But Mina and others say the recent findings also suggest that a patient who has undergone multiple tests with high CT values is likely at the tail end of their infection and need not isolate themselves. He adds that contact tracers should triage their efforts based on CT values. “If 100 files land on my desk [as a contact tracer], I will prioritize the highest viral loads first, because they are the most infectious,” Mina says. Broad access to CT values could also help epidemiologists track outbreaks, Mina says. If researchers see many low CT values, they could conclude an outbreak is expanding. But if nearly all CT values are high, an outbreak is likely waning. “We have to stop thinking of people as positive or negative, and ask how positive?” Mina says. CT values could also help clinicians flag patients most at risk for severe disease and death. A report in June from researchers at Weill Cornell Medicine found that among 678 hospitalized patients, 35% of those with a CT value of 25 or less died, compared with 17.6% with a CT value of 25 to 30 and 6.2% with a CT value above 30. In August, researchers in Brazil found that among 875 patients, those with a CT value of 25 or below were more likely to have severe disease or die. Gandhi agrees that having access to CT values could help clinicians identify people at high risk for developing symptoms. Nevertheless, she and others note that a high viral load doesn’t necessarily lead to disease; some 40% of people who contract SARS-CoV-2 stay healthy even though they have a similar amount of virus to patients who fall ill. “As a physician, having the CT value is not the only thing I will use” to diagnose and track patients, says Chanu Rhee, a hospital epidemiologist at Brigham and Women’s Hospital. “But I do still find it helpful.”

FDA Places Partial Clinical Hold on INOVIO Trial of COVID-19 Vaccine

INOVIO did not detail the FDA’s questions or areas of concern, but did say that it was “actively working to address the FDA's questions and plans to respond in October,” after which the FDA will have up to 30 days to notify INOVIO whether the trial may proceed. + MORE

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Coronavirus Testing Basics [FDA] Source: https://www.fda.gov/media/140161/download

You’ve probably heard a lot about coronavirus testing recently. If you think you have coronavirus disease 2019 (COVID-19) and need a test, contact your health care provider, local pharmacy, or local health departmentExternal Link Disclaimer immediately. The FDA has been working around the clock to increase the availability of critical medical products, including tests for the coronavirus, to fight the COVID-19 pandemic. Learn more about the different types of tests and the steps involved.

Types of Tests There are two different types of tests – diagnostic tests and antibody tests. 1. A diagnostic test can show if you have an active coronavirus infection and should take steps to quarantine or isolate yourself from others. Currently there are two types of diagnostic tests which detect the virus – molecular tests, such as RT-PCR tests, that detect the virus’s genetic material, and antigen tests that detect specific proteins on the surface of the virus. 2. An antibody test looks for antibodies that are made by your immune system in response to a threat, such as a specific virus. Antibodies can help fight infections. Antibodies can take several days or weeks to develop after you have an infection and may stay in your blood for several weeks or more after recovery. Because of this, antibody tests should not be used to diagnose an active coronavirus infection. At this time researchers do not know if the presence of antibodies means that you are immune to the coronavirus in the future.

Different Types of Coronavirus Tests Molecular Test Antigen Test Antibody Test Diagnostic test, viral test, molecular test, Also known nucleic acid Rapid diagnostic test Serological test, serology, blood test, as... amplification (Some molecular tests are also rapid tests.) serology test test (NAAT), RT-PCR test, LAMP test How the Nasal or throat swab sample is (most tests) Nasal or throat swab Finger stick or blood draw taken... Saliva (a few tests) How long it Same day (some Same day (many locations) takes to get locations) or up to a One hour or less or 1-3 days results... week This test is typically Is another highly accurate and Positive results are usually highly accurate but negative Sometimes a second antibody test is test usually does not need results may need to be confirmed with a molecular test. needed for accurate results. needed... to be repeated. What it Diagnoses active Shows if you’ve been infected by Diagnoses active coronavirus infection shows... coronavirus infection coronavirus in the past Show if you ever had Definitively rule out active coronavirus infection. Antigen COVID-19 or were Diagnose active coronavirus infection What it tests are more likely to miss an active coronavirus infected with the at the time of the test or show that you can't do... infection compared to molecular tests. Your health care coronavirus in the do not have COVID-19 provider may order a molecular test if your antigen test past

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Molecular Test Antigen Test Antibody Test shows a negative result but you have symptoms of COVID-19.

There are some new diagnostic tests available with alternative methods and benefits. • Rapid, point-of-care diagnostic tests use a mucus sample from the nose or throat but can be analyzed at the doctor’s office or clinic where the sample is collected and results may be available in minutes. These may be molecular or antigen tests. • At-home collection tests, available only by prescription from a doctor, allow the patient to collect the sample at home and send it directly to the lab for analysis. • Saliva tests allow a patient to spit into a tube rather than get their nose or throat swabbed. Saliva tests may be more comfortable for some people and may be safer for health care workers who can be farther away during the sample collection.

Molecular Tests Many companies and labs have developed tests to diagnose COVID-19 based on detection of the virus’s genetic material in a sample from the patient’s nose or throat. These steps may change as new technology becomes available, but currently the typical steps in molecular testing are: 1. A doctor, pharmacist, or other health professional orders a COVID-19 test. All COVID-19 tests, including those used with a home collection kit, require a prescription or order from a health professional. 2. You or a health care professional use a specialized swab to collect mucus from your nose or throat. 3. You or a health care professional put the swab in a sterile container and seal it for transport to a lab. 4. During the shipping process, most molecular test swabs must be kept within a certain temperature range so that the test will be accurate. The sample must arrive at the lab within 72 hours. 5. A lab technician mixes chemicals with the swab to extract the genetic material of any virus that may be on the swab. 6. The lab technician uses special chemicals, called primers and probes, and a high-tech machine to conduct several controlled heating and cooling cycles to convert the virus's RNA into DNA, and then make millions of copies of the DNA. Some tests use only one warming cycle to make copies of the DNA. 7. When DNA binds to specific probes, a special type of light is produced that can be seen by the machine and the test shows a "positive" result for infection with SARS-CoV-2, the virus that causes COVID-19. The FDA continues to work with test developers to make more coronavirus tests available to more people in the future. Molecular diagnostic tests that detect the genetic material of the virus are commonly used for diagnosing COVID-19 or active coronavirus infection. But no test is 100% accurate all of the time. Some things that may affect the test’s accuracy include: • You may have the virus, but the swab might not collect it from your nose or throat. • The swab or mucus sample may be accidentally contaminated by the virus during collection or analysis. • The nasal or throat swab may not be kept at the correct temperature before it can be analyzed. • The chemicals used to extract the virus genetic material and make copies of the virus DNA may not work correctly.

Antigen Tests Antigen tests usually provide results diagnosing an active coronavirus infection faster than molecular tests, but antigen tests have a higher chance of missing an active infection. If an antigen test shows a negative result indicating that you do not have an active coronavirus infection, your health care provider may order a molecular test to confirm the result.

Antibody (Serology) Tests Antibody tests may provide quick results, but should not be used to diagnose an active infection. Antibody tests only detect antibodies the immune system develops in response to the virus, not the virus itself. It can take days to several weeks to develop enough antibodies to be detected in a test.

How Coronavirus Tests May Be Used Americans rely on the FDA to provide an independent review of medical products, such as drugs, diagnostic tests, and other medical devices. During a public health emergency like the COVID-19 pandemic there is an urgent need for products to diagnose, treat or prevent a medical threat. There are two ways a coronavirus test might be used for this emergency:

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1. Emergency Use Authorization (EUA) In certain types of emergencies, the FDA can issue an Emergency Use Authorization, or EUA, to provide more timely access to critical medical products that may help during the emergency when there are no adequate, approved, and available options. The EUA process is different than full approval or clearance because in some emergency situations we cannot wait for all of the evidence needed for full FDA approval or clearance. Instead, the FDA evaluates the options very quickly using the evidence that is available, carefully balancing the risks and benefits of the product as we know them, in addition to evaluating other criteria. FDA has issued many EUAs for diagnostic tests and antibody tests. To expand the nation’s COVID-19 testing capacity, the FDA also issued a policy guidance offering regulatory flexibility in certain circumstances. The policies in this guidance apply to commercial manufacturers and to laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA) to perform high-complexity testing and who create laboratory-developed tests (LDTs) for coronavirus. In the guidance, the FDA outlines policies for test developers that offer certain types of COVID-19 tests before they receive an EUA for that test, under the circumstances described in the guidance. Under certain policies in the guidance, the test developers validate their test, give notice to FDA, and submit an EUA request within a specified timeframe. 2. State Authorization of LDTs The FDA is providing flexibility to states that want to authorize labs certified to conduct high-complexity testings in that state to develop and perform coronavirus testing. Under this policy, the state or territory takes responsibility for the safety and accuracy of COVID-19 testing by laboratories in its state/territory and the lab does not submit an EUA request to the FDA.

EDITOR’S COMMENT: Please do your own search about what is written (in orange) in the table above. A bit surprised from the info provided by an FDA publication addressing the public.

Gates Vaccine Spreads Polio Across Africa By F. William Engdahl

Sep 29 – The UN has just recently admitted that new cases of infantile paralysis or polio have resulted in Africa from an oral polio vaccine developed with strong support from the Bill and Melinda Gates Foundation. It mirrors what happened in the USA in the 1950s. This is worth a closer look.

F. William Engdahl is strategic risk consultant and lecturer, he holds a degree in politics from Princeton University and is a best-selling author on oil and geopolitics, exclusively for the online magazine “New Eastern Outlook” where this article was originally published. He is a Research Associate of the Centre for Research on Globalization.

Oxford to study anti-inflammatory drug Humira as potential COVID-19 treatment Source: https://www.reuters.com/article/uk-health-coronavirus-oxford/oxford- to-study-anti-inflammatory-drug-humira-as-potential-covid-19-treatment- idUSKBN26L1LL

Sep 30 – Adalimumab, which is sold under the brand name Humira by AbbVie, is a type of anti-inflammatory known as an anti-tumour necrosis factor (anti-TNF) drug. Recent studies have shown that COVID-19 patients already taking anti-TNF drugs for inflammatory bowel disease and inflammatory arthritis are less likely to be admitted to hospital, Oxford said in a statement.

Oxford’s trial, called AVID-CC, will be aimed at treating people in the community, especially in care homes, the university said. It will enrol up to 750 patients from community care settings throughout Britain.

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The Antibody Response to SARS-CoV-2 Infection By Linda Hueston, Jen Kok, Ayla Guibone, et al. Open Forum Infectious Diseases, Volume 7, Issue 9, September 2020, ofaa387 Source: https://academic.oup.com/ofid/article/7/9/ofaa387/5898182

Abstract Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–specific antibodies has become an important tool, complementing nucleic acid tests (NATs) for diagnosis and for determining the prevalence of coronavirus disease 2019 (COVID-19) in population serosurveys. The magnitude and persistence of antibody responses are critical for assessing the duration of immunity.

Methods A SARS-CoV-2-specific immunofluorescent antibody (IFA) assay for immunoglobulin G (IgG), immunoglobulin A (IgA), and immunoglobulin M (IgM) was developed and prospectively evaluated by comparison to the reference standard of NAT on respiratory tract samples from individuals with suspected COVID-19. Neutralizing antibody responses were measured in a subset of samples using a standard microneutralization assay.

Results A total of 2753 individuals were eligible for the study (126 NAT-positive; prevalence, 4.6%). The median “window period” from illness onset to appearance of antibodies (range) was 10.2 (5.8–14.4) days. The sensitivity and specificity of either SARS-CoV-2 IgG, IgA, or IgM when collected ≥14 days after symptom onset were 91.3% (95% CI, 84.9%–95.6%) and 98.9% (95% CI, 98.4%–99.3%), respectively. The negative predictive value was 99.6% (95% CI, 99.3%–99.8%). The positive predictive value of detecting any antibody class was 79.9% (95% CI, 73.3%–85.1%); this increased to 96.8% (95% CI, 90.7%–99.0%) for the combination of IgG and IgA.

Conclusions Measurement of SARS-CoV-2-specific antibody by IFA is an accurate method to diagnose COVID-19. Serological testing should be incorporated into diagnostic algorithms for SARS-CoV-2 infection to identify additional cases where NAT was not performed and resolve cases where false-negative and false-positive NATs are suspected. The majority of individuals develop robust antibody responses following infection, but the duration of these responses and implications for immunity remain to be established.

Moderna, Regeneron COVID-19 Candidates Show Early Positive Data

Moderna's mRNA-1273 and Regeneron’s REGN-COV2 both have the highest “Front Runner” ranking among the more than 300 COVID-19 therapeutics included in GEN’s updated “COVID-19 DRUG & VACCINE CANDIDATE TRACKER.” + MORE

Risk of Severe Coronavirus Linked to Neanderthal Genes From 60,000 Years Ago By Tessa Koumoundouros (Editorial Assistant and Journalist at ScienceAlert) Source: https://www.sciencealert.com/severe-coronavirus-has-been-linked-to-neanderthal-genes-from-60-000-years-ago

Oct 01 – Long ago, in the south of Europe, modern humans and Neanderthals had at least one encounter that resulted in children. While dalliances between our two species are now well documented, no one could possibly have foreseen how grimly they would impact our world 60,000 years later. A resulting stretch of Neanderthal DNA spread far through our populations as it was passed down through the generations, even while the Neanderthals themselves became extinct. Around 50 percent of the people in South Asia and 16 percent of people in Europe now carry this length of DNA, which scientists have now linked to the most severe form of COVID-19. According to the new research, those who have this genetic inheritance are three times more likely to require mechanical ventilation once they contract the virus, explains evolutionary anthropologist Hugo Zeberg from the Max Planck Institute for Evolutionary Anthropology in Germany.

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Scientists have been scrambling to understand what makes some people more vulnerable to SARS-COV-2 than others. The disease has now taken over a million human lives.

While pre-existing underlying conditions and contributing social inequalities explain a large part of our vulnerability, there still stubbornly remains a significant portion of people who are young and healthy yet inexplicably end up with severe respiratory problems, whereas their equally healthy peers only experience the mildest symptoms.

Distribution and prevalence (pie charts) of the Neanderthal genetic variants. (Zeberg et al., Nature, 2020)

Zeberg and geneticist Svante Pääbo from the Okinawa Institute of Science and Technology in Japan analysed genetic data from 3,199 hospitalised COVID-19 patients and saw certain gene variants on chromosome 3 are found together in the population more often than if they were random mutations. Such a long length of DNA, spanning six genes and adding up to 49.4 thousand bases being passed down together, suggests this variation was introduced into the human genome together, meaning it was inherited. Previous research linked this gene region to patients that had a severe reaction to SARS- CoV-2, requiring hospitalisation.

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So Zeberg and Pääbo investigated our extinct human relatives to see where this length of genes came from. They found none of these specific gene variants in the Denisovan genome, and a few of them were found in two Neanderthals from Siberia. But a Neanderthal from Croatia shared the most similarities. These results are "compatible with this Neanderthal being closer to the majority of the Neanderthals who contributed DNA to present- day people," the researchers wrote. Zeberg and Pääbo calculated that it was very unlikely this combination of genes came from a shared ancestor of both humans and Neanderthals, meaning they were introduced when our two species interbred. We don't yet know why this snippet of chromosome 3 increases the risk of severe illness. "This is something that we and others are now investigating as quickly as possible," explained Pääbo. The team suspect that in the past these genes may have proved an advantage for some people - perhaps against another pathogen. A previous study hinted Neanderthal DNA may have provided protection against ancient viruses. This may explain why this now unfortunate variant of chromosome 3 is prevalent in some populations, like in Bangladesh, where 63 percent of people have it, but it's almost absent in others, such as Africa. This distribution could explain why people of Bangladeshi descent in the UK are twice as likely to die from COVID-19 compared to the rest of the population. "It is striking that the genetic heritage from Neanderthals has such tragic consequences during the current pandemic," said Pääbo. Last week, another team identified a potential immune mechanism that may also contribute to severe coronavirus cases. However these genetic pieces of the coronavirus puzzle end up fitting together, it is important to remember that environmental factors also play a large role in whether we even contract the disease in the first place - and that's something we have control over today.

 This research was published in Nature.

Breakthrough – A New Laser-Based Test for COVID-19 Source: https://journal.medizzy.com/breakthrough-a-new-laser-based-test-for-covid-19/

July 19 – More than half a year has passed since the first case of COVID-19 emerged on the surface of the earth. The world has been chaotic since then. The ever-increasing number of deaths and the declining economy has reshaped the thought processes and forced the world to look into ways of getting over the chaos. Rapid and mass screening has become the need of the hour! Up until now, the virus was detected by collecting a sample from the nasopharynx using a swab; the sample is then checked for the virus using the PCR technique. Many of us have been through it, which is not a pleasant test, if not painful. Individuals who are afraid of the swab piercing through the nasal cavity can now sigh in relief! The laser technology is to your rescue! A major breakthrough in the testing of COVID-19 has been made by the Abu Dhabi-based QuantLase Imaging Lab, the medical- research arm of International Holdings Company (IHC). A laser-based, non-invasive test has been devised to give the results within a few seconds. Not only is this laser test quicker, but it is also user-friendly and low-cost!

How does the test work? The Head of the laboratory research team studying the change in the cell structure of the virus-infected blood, Pramod Kumar, said, “The equipment that uses a CMOS detector will allow mass screening with results in seconds. Our laser-based DPI [Diffractive Phase Interferometry] technique, based on optical-phase modulation, can give a signature of infection within a few seconds. What’s more, it is user-friendly, non-invasive, and low-cost. We believe it will be a game-changer in tackling the spread of the coronavirus.” Is the test sensitive enough to detect the virus early in the course? Yes! The DPI technique that is utilized in this test enables the test to detect the virus as early as the blood gets infected, which means that the test can detect the carriers even before the symptoms appear. The accuracy of the test is 85-90%. As Pramod Kumar explained:

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“If we shine a laser on a blood cell and if there is an infection, the blood cell gets deformed or is changed in shape, size, density, morphology. There are various kinds of changes in a blood cell. And because of this change, the light gets scattered. Light gets rebounded and makes a particular pattern on the screen, which will give the signature of the defect of the blood cell due to infection. This is the central idea behind it.”

To further enhance the laser test, especially in mass setting, the lab uses G42, a leading artificial intelligence, and cloud computing company. The advanced artificial intelligence image-analysis model predicts the outcome of each image with precision, speed, and scale.

Abdul Rahman bin Mohammed Al Owais, Minister of Health and Prevention, said: “We are always following innovations related to the early and rapid detection of COVID-19” He further added: “Health officials have been closely monitoring the progress of trials with QuantLase to test this equipment. We are proud to see a technology that works, and that will help to protect our people better.”

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Mental Illness Tied to Increased Mortality in COVID-19 By Batya Swift Yasgur, MA, LSW Source: https://www.medscape.com/viewarticle/938347

Sep 30 – A psychiatric diagnosis for patients hospitalized with COVID-19 is linked to a significantly increased risk for death, new research shows. Investigators found that patients who were hospitalized with COVID-19 and who had been diagnosed with a psychiatric disorder had a 1.5-fold increased risk for a COVID-related death in comparison with COVID-19 patients who had not received a psychiatric diagnosis. "Pay attention and potentially address/treat a prior psychiatric diagnosis if a patient is hospitalized for COVID-19, as this risk factor can impact the patient's outcome — death — while in the hospital," lead investigator Luming Li, MD, assistant professor of psychiatry and associate medical director of quality improvement, Yale New Haven Psychiatric Hospital, New Haven, Connecticut, told Medscape Medical News.

Negative Impact "We were interested to learn more about the impact of psychiatric diagnoses on COVID-19 mortality, as prior large cohort studies included neurological and other medical conditions but did not assess for a priori psychiatric diagnoses," said Li. "We know from the literature that prior psychiatric diagnoses can have a negative impact on the outcomes of medical conditions, and therefore we tested our hypothesis on a cohort of patients who were hospitalized with COVID-19," she added. To investigate, the researchers analyzed data on 1685 patients hospitalized with COVID-19 between February 15 and April 25, 2020, and whose cases were followed to May 27, 2020. The patients (mean [SD] age, 65.2 [18.4] years; 52.6% men) were drawn from the Yale New Haven Health System. The median follow-up period was 8 days (interquartile range, 4 – 16 days). Of these patients, 28% had received a psychiatric diagnosis prior to hospitalization. The patients with psychiatric disorders were significantly older and were more likely to be women, White, non-Hispanic, and to have medical comorbidities (ie, cancer, cerebrovascular disease, congestive heart failure, diabetes, kidney disease, liver disease, myocardial infarction, and/or HIV). Psychiatric diagnoses were defined in accordance with ICD codes that included mental and behavioral health, Alzheimer's disease, and self-injury.

Vulnerability to Stress The following table shows mortality rates of psychiatric vs nonpsychiatric hospitalzed COVID-19 patients (P < .001). 2 weeks 35.7% vs 14.7% 3 weeks 40.9% vs 22.2% 4 weeks 44.8% vs 31.5%

 The study was published September 30 in JAMA Network Open.

Largest study of COVID-19 transmission highlights essential role of super-spreaders By Shashank Bengali Source: https://www.latimes.com/world-nation/story/2020-09-30/largest-covid-19-transmission-study-highlights-super-spreaders

Sep 30 – In the bleak ranking of worst COVID-19 outbreaks, the United States, with 7.2 million infections, is likely to be eclipsed only by India, which has 1 million fewer cases but is catching up fast. Yet parts of India have led the world in one aspect of the pandemic response: contact tracing — the labor-intensive, time-sensitive, painstaking work of identifying people who were exposed to a known infected person. Extensive contact tracing in two southern Indian states offers the strongest evidence yet that a few super-spreading individuals are responsible for a disproportionate share of new

www.cbrne-terrorism-newsletter.com 109 HZS C2BRNE DIARY – October 2020 coronavirus infections, according to a study published Wednesday in the journal Science. It also suggests that children are more efficient transmitters of the virus than widely believed. A team of Indian and U.S. researchers examined data from 575,071 individuals who were tested after coming into contact with 84,965 people with confirmed cases of COVID-19. That’s an average of seven contacts per case, and a cohort more than 10 times larger than in a previous study from South Korea that mapped how the virus was transmitted. “It’s the largest epidemiological study anywhere on COVID by far,” said the lead author, Ramanan Laxminarayan of the Center for Disease Dynamics, Economics and Policy, in New Delhi. Laxminarayan and his colleagues found that just 8% of people with COVID-19 accounted for 60% of the new infections observed among the contacts. Meanwhile, 7 out of 10 COVID-19 patients were not linked to any new cases. The finding underscores the essential role of super-spreaders in the COVID-19 pandemic: One individual or event, such as in a poorly ventilated indoor space, can trigger a high number of new infections, while others might not transmit the virus at all. In the new study, researchers tracked down 78 people who had shared a bus or train with one of eight known infected people and sat within three rows of that person for more than six hours. Health workers visited these contacts at their homes to conduct follow- up screenings and determined that nearly 80% of them had contracted the coronavirus. By contrast, people who were known to be exposed to infected individuals in lower-risk environments — such as being in the same room but more than three feet away — became infected only 1.6% of the time. “Super-spreading events are the rule rather than the exception,” Laxminarayan said. “It has lots of implications for modeling COVID, for how to keep places safe.” The study suggests that super-spreading events are influenced by behavior — that proximity to an infected person, length of contact and ambient conditions determine the level of risk. It doesn’t examine whether some infected people spread the virus more efficiently because of biological factors, a question scientists are still trying to answer. The results could help guide safety measures in places such as gyms, churches and choir practice spaces that have been locations for previous super-spreading events. The study also found that although children younger than 17 were the least likely to die of COVID-19, they transmitted the virus at rates similar to the rest of the population, underscoring the idea that the disease doesn’t spare young people. One data point in particular holds implications for reopening schools: Children ages 5 to 17 passed the virus to 18% of close contacts their own age. Antonio Salas, a Spanish researcher who has investigated the role of super-spreaders in the pandemic, said the study’s findings regarding children were important in light of “previous reports suggesting a minor role of children in the pandemic.” “National policies on how to proceed with children in schools and other social activities could change dramatically if the scientific evidence underpins the idea that children can infect as efficiently as adults, and even more, they could also behave as super- spreaders,” said Salas, who was not involved in the India study. As India’s coronavirus caseload has doubled over the past month, from 3 million to more than 6 million, the study authors said their work showed one strength of the country’s response: the ability to mobilize large numbers of health workers and civil servants to conduct contact tracing, identify high-risk individuals and closely track their cases. The two Indian states in the study, Andhra Pradesh and Tamil Nadu, have a combined population of 128 million and boast some of the largest healthcare workforces and highest levels of public health spending in the country. Both turned to disease-surveillance networks put in place years ago during the AIDS epidemic to make house-to-house checks at levels unseen elsewhere in the world. In Tamil Nadu, which includes the coastal metropolis of Chennai (formerly known as Madras), thousands of public and private healthcare workers were trained as contact tracers and health surveillance officers. The state had experience identifying at-risk populations from its battle against AIDS, which struck Tamil Nadu harder than almost anywhere else in the country. Once a person tested positive for the coronavirus, a public health worker interviewed them by phone about where they’d been and whom they’d met over the previous two weeks. Immediate family members were tested and isolated right away; others were located through phone calls and text messages. Nearly all the contacts traced were people known to the infected person, so many strangers were missed. Still, in Chennai, health workers located and tested an average of 17 contacts per infected person through Aug. 1. Although contact tracing is crucial to identifying, isolating and testing those vulnerable to infection — and helped countries such as South Korea avoid disastrous outbreaks — an effective system has eluded most of the U.S. because of shortages of trained staff and funding. L.A. County’s contact tracing program has failed to stop major outbreaks and been dogged by language barriers, slow turnaround times for test results and inaccurate information from patients. The county has hired about 2,600 contact tracers to cover a population of 10 million. Madurai, a semi-urban district in Tamil Nadu, had an equal number of health workers

www.cbrne-terrorism-newsletter.com 110 HZS C2BRNE DIARY – October 2020 covering a population one-third the size, said Chandra Mohan, a state official who helped oversee the response and was a co-author of the study. Although poorer nations now account for most of the world’s COVID-19 cases, much of what is known about how the coronavirus is transmitted has come from relatively small-scale studies in China, the U.S. and the wealthy nations of Europe. India imposed one of the strictest lockdowns anywhere in late March, measures that the new study found slowed the spread of the virus considerably. As Prime Minister Narendra Modi’s government has eased restrictions to revive the economy, the disease, not surprisingly, has resurged. But Mohan said the contact tracing program saved lives. Tamil Nadu has recorded nearly 600,000 infections and 9,400 deaths, which translates to 13 deaths per 100,000 people. The U.S. COVID-19 mortality rate is roughly 62 per 100,000. “What is required is clarity of thought and the ability to mobilize resources and put them to use,” Mohan said. “I suppose a good governance structure makes the difference between what can be done and what cannot be done.”

Shashank Bengali is a Southeast Asia correspondent for the Los Angeles Times, based in Singapore. He previously covered South Asia from Mumbai, India, and national security from the Washington bureau.

Masks can help block coronavirus-carrying droplets Source: https://www.sdstate.edu/news/2020/09/masks-can-help-block-coronavirus-carrying-droplets

Sep 28 – If you are exposed to the new coronavirus, how likely are you to become infected? How many virus particles you inhale and where they land within the respiratory tract can affect your chances of contracting COVID-19, according to assistant professor Saikat Basu of South Dakota State University’s Department of Mechanical Engineering. “To become infected, you must first inhale the virus, so inhalation patterns are important,” said Basu. He has developed a model that uses breathing rates to track the droplet sizes that are likely to reach the most vulnerable area of the respiratory tract. The modeling is part of a multi-institution National Science Foundation-funded research project to develop a mask with a reusable respirator that captures and kills the novel coronavirus. The good news is masks worn over the nose have the potential to block the droplet sizes that are most likely to reach the initial infection site. The bad news is the virus-carrying droplets that COVID-19 carriers expel dehydrate in the air, increasing their disease- causing potential. “The droplets being inhaled after dehydration in the external air carry a larger viral load,” Basu explained. In lieu of this, the higher relative humidity in countries such as Brazil and India may have been advantageous this summer. The results from the droplet inhalation modeling have been screened by the scientific team at medRxiv, the preprint server for health sciences, and are available online. The corresponding research manuscript is also currently undergoing peer review at PLOS One, an open access scientific journal. SDSU’s high-performance computing cluster was used for part of the aerosol modeling.

Droplets entering through nose A University of North Carolina Chapel Hill cell culture study showed that the upper part of the throat behind the nasal passages and above the esophagus and voice box, known as the nasopharynx, serves as the most accessible seeding zone, Basu explained. Other studies, including one at Oxford University, have confirmed this. “The mucous layer in the anterior nasal passages makes it more difficult for the virus to infect these cells,” Basu noted. Furthermore, the ciliated cells that line the nasopharynx located behind the anterior nasal cavity have a surface receptor, known as ACE2, which the virus uses to enter the cells. The infection then spreads from this initial infection site into the lungs through aspiration of the virus- laden nasopharyngeal fluids. To determine which droplet sizes are most likely to reach the nasopharynx, Basu developed CT-based digital models of the nasal airspace of two healthy adults and simulated four inhalation rates—15, 30, 55 and 85 liters per minute. “The 15-liter rate happens while sitting still and gently breathing and 30 would roughly correspond to your breathing rate while walking,” he explained. Sniffing and breathing in forcefully fall within the range of 60 to 75 liters per minute. “When viral transmission is averaged over different breathing rates, droplets ranging from 2.5 to 19 microns in size do the best job of landing at the nasopharynx,” he noted. These droplets sizes are larger than expected.

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“Most masks would block out these droplet sizes, so wearing a mask is very useful,” Basu said. “These are also the droplet sizes that we need to make sure our new respirator design captures.” In addition, this data will be useful in developing inhaled antiviral therapeutics and targeted intranasal vaccines that reach this initial infection site.

Condensation increasing viral load Based on the reports related to the Skagit Valley choral group in which one-person transmitted COVID-19 to 52 of the 61 choir members, Basu derived a conservative estimate of around 300 virus particles, or virions, as the threshold for infection. “The fact that the number of virus particles needed to launch the infection is in the range of hundreds is very remarkable and shows how contagious this particular virus is,” Basu said. Typically, an inhaled viral infection, such as influenza, requires 1,950 to 3,000 virions. To estimate the probability that a droplet will contain at least one virion, Basu used a study on the amount of virus in the sputum and mucus of COVID-19 patients and then accounted for environment-induced dehydration. A predicted one-third reduction in droplet size means the likelihood that a 10-micron droplet will contain at least one virion increases from 0.37% to 13.6%, he explained. For a 15-micron droplet, that probability increases to 45.8%. This happens because the constituents in the virus-containing droplets are non-volatile. When these constituents evaporate, the concentration of virus particles in the droplets elevates significantly. This may have a significant impact on COVID-19 transmission this winter, as the relative humidity drops and subsequently triggers a higher rate of dehydration for the ejected respiratory droplets, Basu pointed out. In addition, the closed-door ventilation system during the winter months may increase the probability of airborne transmission.

Due to Extremely Rare Situation, Woman Suffers Brain Fluid Leak From COVID-19 Swab Source: https://www.sciencealert.com/improperly-done-nasal-swab-test-caused-a-brain-fluid-leak-in-us-patient

Oct 02 – A COVID-19 nasal swab test punctured a US woman's brain lining, causing fluid to leak from her nose and putting her at risk of life-threatening infection, doctors reported in a medical journal Thursday. The patient, who is in her 40s, had an undiagnosed rare condition and the test she received may have been carried out improperly, a sequence of improbable events that means the risk from nasal tests remains very low. But her case showed health care professionals should take care to follow testing protocols closely, Jarrett Walsh, senior author of the paper that appeared in JAMA Otolaryngology–Head & Neck Surgery, told AFP. People who've had extensive sinus or skull base surgery should consider requesting oral testing if available, he added. "It underscores the necessity of adequate training of those performing the test and the need for vigilance after the test has been performed," added ear, nose and throat specialist Dennis Kraus of Lenox Hill Hospital in New York, who wasn't involved in the paper. Walsh, who practices at the University of Iowa Hospital, said the woman had gone for a nasal test ahead of an elective hernia surgery, and afterward noticed clear fluid coming out of one side of her nose. She subsequently developed headache, vomiting, neck stiffness, and aversion to light, and was transferred to Walsh's care. "She had been swabbed previously for another procedure, same side, no problems at all. She feels like maybe the second swab was not using the best technique, and that the entry was a little bit high," he said. In fact, the woman had been treated years earlier for intracranial hypertension - meaning that the pressure from cerebrospinal fluid that protects and nourishes the brain was too high. Doctors at the time used a shunt to drain some of the fluid and the condition resolved. But it caused her to develop what's called an encephalocele, or a defect at the base of the skull which made the brain's lining protrude into the nose where it was susceptible to rupture. This went unnoticed until old scans were reviewed by her new doctors, who carried out surgery to repair the defect in July. She has since fully recovered. Walsh said he believes the symptoms she developed were a result of irritation to the lining of the brain.

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A, Brain computed tomographic image from 2017 in the coronal and sagittal planes demonstrating encephalocele situated over the fovea ethmoidalis prior to nasopharyngeal testing for COVID-19. The arrowhead demonstrates skull base defect. B and C, High- resolution magnetic resonance imaging (T2 sequence) in the sagittal plane during hospital admission in July 2020 after development of iatrogenic CSF leak. The yellow arrowheads indicate the encephalocele.

If the problem hadn't been treated, she could have developed a potentially life-threatening brain infection from bacteria that traveled up the nose. Or, air could have entered the skull and placed excess pressure on the brain. Most testing protocols call for clinicians to follow the path of the floor of the nose, which lies above the roof of the mouth, rather than pointing the swab up - or if they point it up, to do so with great care. Walsh said that though this was likely a very rare occurrence, it was a reminder of the need for high-quality training, given that hundreds of millions more tests will be performed before the pandemic is over.

Chamorro, colleagues engineering novel protective mask Source: http://mechanical.illinois.edu/news/chamorro-colleagues-engineering-novel-protective-mask

Apr 28 – Supported by the NSF Rapid Response Research funding mechanism, MechSE Associate Professor Leonardo P. Chamorro is working with Associate Professor Sunghwan Jung at Cornell University and Assistant Professor Saikat Basu at SDSU on a novel, highly-efficient, virus-preventive respirator mask inspired by nasal structures of animals with enhanced olfactory sensitivity. Small aerosol droplets that can carry viruses will be captured from inhaled air by using a combination of copper-based filters and a bio-inspired tortuous passage with periodic thermal gradients induced by spiral copper wires. The aerosol capture will be articulated by modulating the dynamics of flow structures in the convoluted geometry (a vortex trap) and by thermophoresis action along the respirator’s internal walls (a thermal trap). Cyclic cold/hot temperature changes on the walls, along with ionic activity from the copper material, will be used to inactivate the trapped viruses. The vortex trap is an animal-inspired, topologically complex air-transmission passage of the respirator. It promotes the formation of large-scale secondary flows, as well as large- and small-scale coherent vortices that result in localized flow separation, reduced velocity, and particulate attractors. These mechanisms allow implementing efficient engineering strategies for virus deactivation via heat and copper-based ionic processes. The thermal trap of the respirator uses the thermophoresis effect where temperature gradient can drive sufficiently small particles towards cooler surfaces; it can be used as a complementary mechanism to collect particulates and viruses within the mask. A comparatively cold wall attracts, and a hot wall repels tiny particulates.

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The project will integrate the theoretical, experimental, and computational expertise of the principal investigators in optimizing the design for a new-age respirator, which can be radically more effective in preventing the transmission of COVID-19. By preventing nosocomial transmission, the product can also be a critical game-changer for the healthcare community. The team seeks collaboration with virology labs and pharmaceutical companies for detailed testing with live COVID samples and accelerated concept- to-product transition.

This incredibly smart face mask protects and eliminates inconveniences for doctors Source: https://siliconcanals.com/news/this-smart-face-mask-eliminates-inconveniences-doctors/

Aug 28 – As cities reopen from lockdown or stay-at-home ordinance, masks have become mandatory across the globe to reduce the spread of COVID-19. A rising number of people, especially the doctors and nurses on the front line of the battle fighting against Coronavirus feels that the face mask makes communication difficult, is often misused, and irritates the face. For example, during COVID times, in the operating room, surgical masks must be combined with a face shield, which makes communication at the operating table more difficult.

Smart face mask is here Since the status quo warrants everyone to wear face masks, a team of Belgian entrepreneurs and experts from Forcit Benelux and Holst Center have prepared a prototype of a ‘smart face mask’ to eliminate the practical inconveniences for doctors. “The momentum is there. The market is ripe, the business plan is foolproof, and the expertise and technology are available”, says Henri Jacobs, Managing director of Forcit Benelux, one of the initiators.

Make people’s lives safer and easier It is worth noting that the ‘smart face mask’ is aimed at the professional (medical) world. “It was Dr Verougstraete who triggered the demand for more intelligent masks”, says Henri Jacobs. “Today, you do not find smart masks specifically intended for the medical sector on

www.cbrne-terrorism-newsletter.com 114 HZS C2BRNE DIARY – October 2020 the global market. So far, there are only smart masks without certification that can be applied in air-polluting situations. Which, therefore, do not meet the European (medical) standards and certification”.

Compatible with apps The development of a smart mask happens in two phases – first generation and second generation. The first-gen smart mask can amplify voice through a built-in microphone and speaker, notifies filter replacement time, learn from data analysis based on breathing, and of course, make breathing easier. The mask can be connected to the app as well.

Second-gen masks will have sensors In a second-generation, sensors in the mask will measure and report data via the linked app. Furthermore, technology, including monitor parameters such as temperature, oxygen saturation, breathing rhythm, and more will be added at a later stage. This way, the mask can preventively monitor and predict a user’s state of health.

Offered exclusively to doctors The pilot version of the first generation of the “smart face mask” uses 3D printing for production and integrates Holst Centre’s communication technology. The intelligent mask is widely applicable to doctors, nurses, and patients. Henri Jacobs: “Everyone is initially thinking about protection against COVID-19, but once finalised, the ‘smart face mask’ must enable early detection of respiratory infections”.

The Pandemic That Never Was By Michael J. Talmo Global Research, October 01, 2020 Source: https://www.globalresearch.ca/pandemic-never-was/5725344

Anti-Science Extremism in America: Escalating and Globalizing By Peter Hotez Source: https://www.sciencedirect.com/science/article/pii/S1286457920301581

Sep 19 – On August 29, 2020, a large protest against the German Government and their coronavirus restrictions, especially requirements for masks and social distancing, took place in Berlin. An estimated 18,000-38,000 “corona-truthers” showed up, with reports that far-right groups, including the Alternative für Deutschland (AfD, Alternative for Germany) - a populist and German nationalist political party, and Nationaldemokratische Partei Deutschlands (NPD, National Democratic Party of Germany) - a “neo- Nazi” party, organized and promoted the event [1, 2, 3]. The marches culminated in an attempt by the protestors to storm the Reichstag, the German Parliament [3]. Among the featured speakers in Berlin was Robert F Kennedy, Jr, a leading anti-vaccine activist in the United States [1, 2], and on the following day on Twitter his Children’s Health Defense organization thanked “all the dedicated health freedom advocates” for their support [4]. The German protests received only modest attention in the American press, but they have ominous implications. They confirm earlier (2017) predictions that an American anti-science movement would aspire to achieve a global footprint [5, 6]. The fear is that the recent events in Berlin may herald the start of an anti-science movement of truly global dimensions, and one tied to extremist groups.

Health Freedom and the Political Far Right The modern antivaccine movement is more than twenty years old, beginning with an initial Lancet publication (later retracted) claiming that the measles-mumps-rubella (MMR) vaccine had a role in causing autism [5]. However, its sharp political turn and dimension is more recent. In 2015, the antivaccine movement pivoted to the far right under the brand or moniker of “health freedom” or “medical freedom”. In that year before the US presidential election, antivaccine political action committees (PACs) formed in Texas and elsewhere, linking to the American Tea Party and its protests against government interference [7]. Shortly afterwards, major conservative pundits and media outlets began supporting antivaccine groups, coinciding with statements against vaccines made by President Trump during his presidential run. Following the election victory, Robert F. Kennedy Jr announced in January 2017 he was invited to head a federal commission on

www.cbrne-terrorism-newsletter.com 115 HZS C2BRNE DIARY – October 2020 vaccine safety, but this was subsequently denied by the Trump transition team [8]. In 2018 he established the Children’s Health Defense as “a new organization expanding the mission of the World Mercury Project” [9], which together with the for-profit Stop Mandatory Vaccination are currently considered two of the most visible antivaccine groups [10, 11]. Beyond health freedom slogans and rallies, antivaccine activities in the US embraced the targeting of minority groups to convince them that vaccines cause autism [12], in some cases invoking exploitative Holocaust references and imagery [13]. By 2018, more than a dozen large urban counties were predicted to be at risk for the rise of vaccine-preventable diseases due to large numbers of school vaccine exemptions [14]. A year later measles outbreaks erupted in several of these counties, as well as among an Orthodox Jewish population in New York. Measles had returned to the US almost two decades after it was eliminated from the United States [15, 16].

Combining Antivaccine and COVID-19 Denial With the emergence of coronavirus disease of 2019 (COVID-19) in 2020, antivaccine groups in the United States took on an expanded remit against science. Although these groups did not speak with one voice, they exhibited several common elements and features, including efforts to deny or minimize COVID-19, or to protest public health measures, such as testing, contact tracing, or social distancing [17, 18]. Health freedom was a major theme, as were other aspects more or less along the lines of the German protests in August. Conspiracy theories featured prominently. COVID-19 vaccines or other measures came to represent a device or ploy to monitor population movements, while Bill Gates was targeted for allegedly hoping to vaccinate against COVID-19 as a means to implant microchip-tracking devices [19]. During April and May of 2020, anti-COVID-19 and antivaccine activities melded and manifested as public protests in multiple US states, with an emphasis on opposing testing, contact tracing, and government-mandated social distancing (Fig. 1) [20].

Fig. 1. Health freedom protests in Ohio. By Wikimedia user Becker1999

For example, in Texas, the antivaccine group, Texans for Vaccine Choice, launched a campaign against contact tracing, asking its adherents make it known how they “do not wish to be monitored or surveilled for any reason” [21]. Similarly, in California a group calling itself “Freedom Angels” and Californians for Health Choice expanded their antivaccine activities to promote the reversal of social distancing mandates [22]. According to the Washington Post and other news sources, the spring coronavirus protests against social distancing were endorsed by President Trump, with one of his tweets reminiscent of the Charlottesville, Virginia riots, “these are very good people, but they are angry. They want their lives back again, safely!” [23].

Globalizing the New Anti-Science: The New Triumvirate The consequences of the spring protests were both predicted and predictable. The US experienced a massive resurgence across conservative and right-leaning Southern states, led by governors supportive of the protestors. At one point in the summer, the American South and Southwest regions accounted for the highest number of new COVID-19 cases globally [24].

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By the end of the summer of 2020, there was evidence that the US anti-science movement directed against vaccines and COVID- 19 had expanded into Europe. Far right protestors in Berlin, Germany carried signs and posters exclaiming, “Trump, Please Help” with the logo representing QAnon, a far right wing conspiracy alleging satanic plots against the President [1, 2]. Days after the event, The Daily Beast reported: “Admiration for Kennedy and hatred for Gates connects QAnon conspiracy theorists, far-right extremists and the more mainstream corners of anti-COVID activism” [25]. Still another dimension are reports that the Russian media published parts of the Kennedy speech [25], while spreading disinformation about COVID-19, including the promotion of conspiracies around migrants and Chinese involvement [26]. Russian anti-science bots and trolls are now alleged to contribute significantly to this organized disinformation campaign, or “weaponized health communication” [27, 28]. In ancient Rome, the first triumvirate referred to an alliance of three major politicians of their Republic – Pompey, Marcus Crassus, and Julius Caesar (Fig 2). A new triumvirate has now formed around anti-science comprised of prominent anti-science PACs and organizations in the US, nationalist or neo-nazi political organizations in Germany, and Russian disinformation launched by the government and media.

Fig. 2. The First Triumvirate: Caesar, Crassus, and Pompey. By Wikimedia users Andreas Wahra, Diagram Lajard

Attributing specific responsibility or blame for the emergence of measles and COVID-19 in the US and global vaccine hesitancy to the triumvirate or its individual components remains elusive. This should not be surprising given their activities operate through underground communities on the dark web and are not easily searchable [28]. Combating or defusing the anti-science triumvirate will require extensive international cooperation and input from the World Health Organization (WHO) and other United Nations agencies. In 2019, the WHO listed vaccine hesitancy as a global health priority, but this issue has since grown in size and scope [15]. The anti-science movement that began in the US is now a full on multi-national phenomenon, and one that could accelerate and dismantle the global health gains over the last two decades.

 References are available at source’s URL.

Peter J. Hotez is with Texas Children’s Center for Vaccine Development, Departments of Pediatrics and Molecular Virology & Microbiology, National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas, USA.

MUST READ! Not sick enough to worry? "Influenza-like" symptoms and work-related behavior among healthcare workers and other professionals: Results of a global survey By Ermira Tartari, Katja Saris, Nikki Kenters, et al. PLoS ONE 15(5): e0232168. Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0232168

Healthcare workers (HCWs) and non-HCWs may contribute to the transmission of influenza-like illness (ILI) to colleagues and susceptible patients by working while sick (presenteeism). The present study aimed to explore the views and behavior of HCWs and non-HCWs towards the phenomenon of working while experiencing ILI.

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Methods The study was a cross-sectional online survey conducted between October 2018 and January 2019 to explore sickness presenteeism and the behaviour of HCWs and non-HCWs when experiencing ILI. The survey questionnaire was distributed to the members and international networks of the International Society of Antimicrobial Chemotherapy (ISAC) Infection Prevention and Control (IPC) Working Group, as well as via social media platforms, including LinkedIn, Twitter and IPC Blog. Results In total, 533 respondents from 49 countries participated (Europe 69.2%, Asia-Pacific 19.1%, the Americas 10.9%, and Africa 0.8%) representing 249 HCWs (46.7%) and 284 non-HCWs (53.2%). Overall, 312 (58.5%; 95% confidence interval [CI], 56.2–64.6) would continue to work when sick with ILI, with no variation between the two categories. Sixty-seven (26.9%) HCWs and forty-six (16.2%) non-HCWs would work with fever alone (p<0 .01) Most HCWs (89.2–99.2%) and non-HCWs (80%-96.5%) would work with “minor” ILI symptoms, such as sore throat, sinus cold, fatigue, sneezing, runny nose, mild cough and reduced appetite. Conclusion A future strategy to successfully prevent the transmission of ILI in healthcare settings should address sick-leave policy management, in addition to encouraging the uptake of influenza vaccine.

Timeline of ECDC's reponse to COVID-19 Source: https://www.ecdc.europa.eu/en/covid-19/timeline-ecdc-response

Scroll through the interactive timeline to see the main ECDC outputs and developments since the beginning of the COVID-19 pandemic.

Event background On 31 December 2019, the Wuhan Municipal Health Commission in Wuhan City, Hubei province, China, reported a cluster of pneumonia cases (including seven severe cases) of unknown aetiology, with a common reported link to Wuhan's Huanan Seafood Wholesale Market, a wholesale fish and live animal market [1]. On 1 January 2020, the market was closed down. According to the Wuhan Municipal Health Commission, samples from the market tested positive for a novel coronavirus. Cases showed symptoms such as fever, dry cough and dyspnoea; radiological findings showed bilateral lung infiltrates [2]. On 9 January 2020, China’s CDC reported that a novel coronavirus (later named SARS-CoV-2, the virus causing COVID-19) had been detected as the causative agent for 15 of the 59 cases of pneumonia [3]. On 9 January 2020, ECDC published a Threat Assessment Brief on the cluster of pneumonia possibly associated with a novel coronavirus in Wuhan, China [4]. On 10 January 2020, the first novel coronavirus genome sequence was made publicly available [5]. The sequence was deposited in the GenBank database (accession number MN908947) and uploaded to the Global Initiative on Sharing All Influenza Data (GISAID). On 17 January 2020, ECDC published its first risk assessment on the novel coronavirus [6].

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By 20 January 2020, there were reports of confirmed cases from three countries outside China: Thailand, Japan and South Korea [7]. These cases had all been exported from China. On 23 January 2020, Wuhan City was locked down – with all travel in and out of Wuhan prohibited – and movement inside the city was restricted [8]. On 24 January 2020, the first European case was reported in France. This case had a travel history to China [9]. On 28 January 2020, Germany, also reported cases, related to a person visiting from China [10]. On 30 January 2020, the World Health Organization (WHO) declared this first outbreak of novel coronavirus a ‘public health emergency of international concern’ [11]. On 22 February 2020, and over the following days, the Italian authorities reported clusters of cases in several regions (Lombardy, Piedmont, Veneto etc). During the following week, several European countries reported cases of COVID-19 in travellers from the affected areas in Italy, as well as cases without epidemiological links to Italy, China or other countries with ongoing transmission [12]. On 8 March 2020, Italy issued a decree to install strict public health measures including social distancing, starting in the most affected regions and on 11 March 2020 extending these measures at national level. Following this, Spain, France and many other European countries installed similar public health measures [13]. On 11 March 2020, the Director General of the WHO declared COVID-19 a ‘global pandemic’ [14]. As of 25 March 2020, all EU/EEA countries and more than 150 countries worldwide had been affected. On 3 April 2020, the number of confirmed COVID-19 cases reported worldwide surpassed one million. On 8 April 2020, ECDC provided its expert opinion on the use of face masks in public by individuals who are not ill to reduce potential pre-symptomatic or asymptomatic transmission of COVID-19. This opinion was translated into 26 languages [15]. On 14 April 2020, the European Commission, in cooperation with the President of the European Council, put forward a European roadmap towards lifting coronavirus containment measures [16]. During the course of April 2020, many EU/EEA countries started to adjust their response measures (i.e., the gradual opening of schools, small shops and other businesses) [17]. On 23 April 2020, the number of confirmed cases of COVID-19 in the EU/EAA and the United Kingdom (UK) surpassed one million. On 27 April 2020, health authorities in the UK warned of a number of seriously ill children with multisystem inflammatory syndrome associated with COVID-19, presenting with signs of circulatory shock and hyperinflammatory state, with features consistent with toxic shock or Kawasaki disease [18]. On 13 May 2020, the European Commission presented guidelines and recommendations to help Member States gradually lift travel restrictions, with all the necessary safety and precautionary means in place [19]. On 21 May 2020, the European Union Aviation Safety Agency (EASA) and ECDC jointly published guidance for the management of airline passengers in relation to the COVID-19 pandemic [20]. On 17 June 2020, the European Commission presented a European strategy to accelerate the development, manufacture and deployment of vaccines against COVID-19 [21]. On 29 June 2020, the number of confirmed cases of COVID-19 worldwide surpassed 10 million. On 9 July 2020, the WHO’s Director-General announced the initiation of the Independent Panel for Pandemic Preparedness and Response (IPPR) to evaluate the world’s response to the COVID-19 pandemic [22]. On 27 July 2020, the European Maritime Safety Agency (EMSA) and ECDC jointly published guidance for cruise ship operations in relation to the COVID-19 pandemic [23]. On 12 August 2020, the number of confirmed COVID-19 cases worldwide surpassed 20 million. On 28 August 2020, ECDC launched a tutorial on ‘how to wear a face mask properly’ [24]. On 4 September 2020, the European Commission adopted a proposal for a European Council recommendation to ensure that any measures taken by Member States that restrict free movement due to the coronavirus pandemic are coordinated and clearly communicated at the EU level [25]. On 18 September 2020, ECDC published its testing strategies and objectives of populations in various epidemiological situations [26]. On 18 September 2020, the European Medicines Agency endorsed the use of dexamethasone for COVID-19 patients on oxygen or mechanical ventilation [27]. On 18 September 2020, the number of confirmed COVID-19 cases worldwide surpassed 30 million. On 21 September 2020, ECDC published a Threat Assessment Brief on re-infection, following reports of cases with suspected or possible reinfection with SARS-CoV-2 [28].

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On 24 September, ECDC published the 12th update of its risk assessment on COVID-19 in the EU/EEA and the UK, evaluating the risk of COVID-19 in coming weeks and months with particular attention to the impact on healthcare services due to the increase of COVID-19 cases observed following the summer and the lifting of some control and preventive measures. This was a reminder that the pandemic is far from over [29].

 References available at source’s URL.

Mysterious Post-COVID Syndrome Found in Kids Is Now Also Affecting Adults Source: https://www.sciencealert.com/weird-inflammatory-syndrome-tied-to-covid-19-strikes-adults-as-well-as-kids

Oct 03 – Months after the discovery of a "multisystem inflammatory syndrome" tied to COVID-19 in children, health officials are warning that a similar condition can strike adults as well. On Friday (October 2), the Centers for Disease Control and Prevention (CDC) released a report describing a "multisystem inflammatory syndrome in adults" or (MIS-A). Like the syndrome in children, MIS-A is a severe illness that targets multiple organs and causes increased inflammation in the body, the report said. And with both syndromes, many patients either test positive for SARS-CoV-2, the virus that causes COVID-19, or have antibodies against it, indicating a recent infection. Currently, MIS-A appears rare, like its counterpart in children. The new CDC report identifies around two dozen cases of MIS-A. Still, the new report, published in the CDC journal Morbidity and Mortality Weekly Report, urges doctors to consider a diagnosis of MIS-A in adults with compatible signs and symptoms. "Ultimately, the recognition of MIS-A reinforces the need for prevention efforts to limit spread of SARS-CoV-2," the authors concluded.

Adult syndrome Reports of a mysterious inflammatory syndrome in children first appeared in the spring, and doctors dubbed the condition MIS-C, or "multisystem inflammatory syndrome in children." Children with this rare syndrome, which affects multiple organs and often requires hospitalization, can experience fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, and fatigue, according to the CDC. So far, the CDC has received reports of 935 cases of MIS-C in the United States, including 19 deaths. The official definition of MIS-C includes an age limit of 20 years old, and cases have been seen in children, teens and young adults. Over the summer, there were reports of a similar syndrome popping up in adults. The new CDC report describes 27 cases of MIS-A from the United States and the United Kingdom. Sixteen of these cases are described in detail, nine of which were officially reported to the CDC, and seven of which were described in published case reports. Among the 16 cases, patients ranged in age from 21 to 50 years old. Just one case was reported in the UK, with the rest reported in the US, including cases in Maine, Florida, Louisiana, Georgia, New York, Massachusetts, and Texas. Some adult symptoms were similar to those seen in children, including fever, gastrointestinal symptoms, and rash. Some patients reported chest pain or heart palpitations, and all had elevated levels of markers of inflammation. All of the patients had either a positive COVID-19 test or positive antibody test. Ten patients required treatment in the intensive care unit, and two patients died, the report said. The findings "indicate that adult patients of all ages with current or previous SARS-CoV-2 infection can develop a hyperinflammatory syndrome resembling MIS-C," the authors wrote. The authors note that hospitalized patients with COVID-19 in general can experience inflammation and effects on organs beyond the lungs. However, in most cases, those effects are accompanied by serious respiratory problems. However, with MIS-A, patients haven't shown serious respiratory symptoms. Of the 16 patients, half did not have any respiratory symptoms, and half had only mild ones. Concerningly, of 22 patients in the study with information on race/ethnicity available, all but one patient belonged to a minority group. "Long-standing health and social inequities have resulted in increased risk for infection and severe outcomes from COVID-19 in communities of color," the authors said.

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A similar trend has been seen in children with MIS-C — more than 70 percent of reported U.S. cases have occurred in children who are Hispanic or Black, according to the CDC. The underlying causes of MIS-C and MIS-A are not known. But 30 percent of adults in the current report and 45 percent of a sample of 440 children with MIS-C tested negative for SARS-CoV-2, but positive for antibodies against the virus, "suggesting MIS-A and MIS-C might represent postinfectious processes," the authors wrote. Further research is needed to understand the exact causes of this condition and its long-term effects, they concluded.

 Read the original article here.

A laboratory-based study examining the properties of silk fabric to evaluate its potential as a protective barrier for personal protective equipment and as a functional material for face coverings during the COVID-19 pandemic By Adam F. Parlin, Samuel M. Stratton, Theresa M. Culley, and Patrick A. Guerra PLoS ONE 15(9): e0239531 | September 18, 2020 Source: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239531

The worldwide shortage of single-use N95 respirators and surgical masks due to the COVID-19 pandemic has forced many health care personnel to use their existing equipment for as long as possible. In many cases, workers cover respirators with available masks

in an attempt to extend their effectiveness against the virus. Due to low mask supplies, many people instead are using face coverings improvised from common fabrics. Our goal was to determine what fabrics would be most effective in both practices. Under laboratory conditions, we examined the hydrophobicity of fabrics (cotton, polyester, silk), as measured by their resistance to the penetration of small and aerosolized water droplets, an important transmission avenue for the virus causing COVID-19. We also examined the breathability of these fabrics and their ability to maintain hydrophobicity despite

www.cbrne-terrorism-newsletter.com 121 HZS C2BRNE DIARY – October 2020 undergoing repeated cleaning. Laboratory-based tests were conducted when fabrics were fashioned as an overlaying barrier for respirators and when constructed as face coverings. When used as material in these two situations, silk was more effective at impeding the penetration and absorption of droplets due to its greater hydrophobicity relative to other tested fabrics. We found that silk face coverings repelled droplets in spray tests as well as disposable single-use surgical masks, and silk face coverings have the added advantage over masks such that they can be sterilized for immediate reuse. We show that silk is a hydrophobic barrier to droplets, can be more breathable than other fabrics that trap humidity, and are re-useable via cleaning. We suggest that silk can serve as an effective material for making hydrophobic barriers that protect respirators, and silk can now be tested under clinical conditions to verify its efficacy for this function. Although respirators are still the most appropriate form of protection, silk face coverings possess properties that make them capable of repelling droplets.

EDITOR’S COMMENT: Silk contains copper that can kill bacteria and viruses on first contact. Silkworms eat mulberry leaves, thus incorporating copper into their silk from their diet.

Window seat passengers at more risk of contracting Covid-19 on flights, study finds Source: https://www.thenational.ae/uae/health/coronavirus-window-seat-passengers-at-more-risk-of-contracting-covid-19-on- flights-study-finds-1.1087487

Oct 03 – Airline passengers are more at risk of catching the coronavirus if they sit in a window seat, a new study has found, contradicting the widely held belief that those in aisle seats would be more exposed. The findings come from a detailed analysis of passengers on a Qantas flight in March during which as many as 11 people were infected. It also indicated that passengers in the middle of the economy section of the Airbus A330 aircraft were more likely to catch the virus than those in the rear. Sitting within two rows of an infected person was also a risk factor. The researchers, based at universities and public health institutions in Western Australia, where the Qantas flight landed, said they had not expected to find window seats involved a greater risk of exposure. “This finding was unanticipated given the widely held view that persons in window seats are at lower risk for exposure to an infectious pathogen during flight,” they wrote in Emerging Infectious Diseases. The prevailing view, they said, had been supported by simulations of respiratory illness transmission during flights of a similar length on planes in the US. Of the 243 passengers on the five-hour Sydney-to-Perth service, 11 were infectious at the time of travel. Nine of these infectious people had earlier that day disembarked a cruise ship, the Ruby Princess, that suffered a notorious outbreak in which hundreds were infected and more than two dozen died. The 11 infectious passengers were spread evenly through the economy section of the plane, with six in the mid- cabin section and five in the aft, or rear section.

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Detailed genetic study of the coronavirus strains of passengers found that the flight almost certainly resulted in eight people being infected, with a further three possibly infected. The researchers could more easily work out the pattern of infections on the plane because the passengers from the Ruby Princess had a unique strain of the coronavirus called A2-RP. Of the 11 coronavirus cases thought to have been caused by the flight, known as secondary cases, seven – or 64 per cent – were among people who had been seated by a window. This finding that window passengers were more likely to be infected was highly statistically significant. It contrasts with research from 2018, partly funded by Boeing, that found aisle seats were more likely to be contaminated with pathogens because people touched them with their hands or brushed against them as they walked past. The new study also found that eight of the 11 secondary cases on the flight – on which mask wearing was said to be rare – involved passengers seated within two rows of infectious tourists from the Ruby Princess ship. Two people possibly infected on the flight were three rows away and one person known to have contracted coronavirus on the flight was six rows from an infectious passenger. The 2018 Boeing-funded study, which analysed the spread of another coronavirus, Sars, on board aircraft, also suggested passengers seated within two rows of an infectious person were most at risk. That research considered several ways by which pathogens could spread and found that touching contaminated surfaces was the biggest risk, causing as much of a hazard as close person-to-person contact and contamination from the surrounding air combined. The aircraft industry has previously argued that the risk of airborne infection on flights is extremely low because of air filtering. Two years ago, the International Air Transport Association released a report that said filters removed “virtually all viruses and bacteria”.

EDITOR’S COMMENT: What is the point of such publications the moment (a) the virus is airborne; (b) has not been specified how many virons are required to get sick; (c) there is no reference if passengers were wearing masks and remained seated the entire flight, and (d) the type of air filters the airliner was equipped with to clean cabin’s air.

As the World Focuses on Coronavirus Another Devastating Health Threat Is Brewing Source: https://www.sciencealert.com/as-the-world-focuses-on-coronavirus-another-devastating-health-threat-is-brewing

Oct 05 – While the world struggles to end the COVID-19 pandemic, experts say we're already dealing with another global infectious- disease threat. Antibiotic-resistant bacteria don't get as much attention as COVID-19, since the diseases they cause spread slowly and steadily, rather than taking the world by storm in a short period of time. But bacteria could become a COVID-19-level threat, experts say. And it will happen in a slow march. According to the CDC, nearly 3 million Americans per year contract an antibiotic-resistant bacterial infection. Of those, roughly 35,000 die. Globally, approximately 700,000 die from these infections every year. The World Health Organisation projects that, at current rates, around 10 million people could die from antibiotic-resistant infections annually by 2050. Because of the overprescription of antibiotics, the overuse of them in livestock, and other factors, many different kinds of bacterial infections including strains of gonorrhea, tuberculosis, and salmonella have become extremely hard, sometimes even impossible, to treat. That's because the tiny portion of bacteria that survive these antibiotics evolve and reproduce, developing resistance. Around the world, 230,000 die each year from antibiotic-resistant tuberculosis alone. "It's increasingly likely that that bacterial infection will be very difficult to treat if not untreatable, and untreatable bacterial infections are bad. Untreatable bacterial infections do a lot of damage," Sarah Fortune, a professor of immunology and infectious diseases at Harvard University, told Insider. "They kill people." Steffanie Strathdee, a professor of medicine at the University of California, San Diego, told Insider that we're not talking about the threat nearly enough.

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"Unlike COVID-19, which came along suddenly and burst on the scene, the superbug crisis has been simmering along," Strahdee said. "It's already a pandemic. It's already a global crisis, and it's getting worse under COVID." Tom Frieden, the former CDC director and the CEO of Resolve to Save Lives, told Insider that the US government needs a more aggressive and multifaceted approach to fight what he calls "nightmare bacteria." He added that the medical community should focus in particular on how infectious disease spread through hospitals "I have absolutely no doubt that in 20 or 40 years, we will look back at healthcare as it was implemented in 2020 and shake our heads in wonder about how they could have let so many infections spread in healthcare facilities," Frieden said. "We're just not anywhere near where we need to be in terms of infection prevention and control."

An antibiotic test. (Brian Snyder/Reuters)

A 'dysfunctional' public-health system makes the problem hard to fix Much of the attention and resources that would be devoted to the bacteria threat are currently directed toward trying to defeat COVID-19, Strathdee said. In that sense, the coronavirus pandemic may, perversely, be making the antibiotic-resistant bacteria problem worse.

Micrograph of methicillin-resistant Staphylococcus aureus (MRSA). (Callista Images/Cultura/Getty Images) In July, the WHO called for more careful use of antibiotics among COVID-19 patients to help curb the threat of antibiotic resistance. A May review found that among about 2,000 hospitalized COVID- 19 patients worldwide, 72 percent received antibiotics even though only 8 percent had documented bacterial or fungal infections. As bacteria become more resistant to antibiotics, the risk of catastrophic consequences increases. E. coli, for example, causes millions of urinary-tract infections every year. If an extremely antibiotic-resistant strain of it develops, it could spread and kill "countless young women," according to Lance Price, founding director of the Antibiotic Resistance Action Centre at George Washington University. "They could go to the doctor with what they think is a routine bladder infection and end up dead from bloodstream infections as the doctors try and fail to treat their infections as it ascends from the bladder to the kidneys and into the blood," Price said. The COVID-19 pandemic, Price added, has exposed how our "dysfunctional" public-health system "has left us vulnerable to slow- spreading, antibiotic-resistant bacteria." "The US is not prepared to deal with bacterial pandemics, as proven by our inability to deal with many simultaneous, ongoing epidemics and pandemics of multidrug-resistant bacteria that are currently circulating," Price said. Fortune told Insider that bacteria will gain resistance to new antibiotics over time, so we'll have to be careful about how we use them and keep developing new drugs to face the problem. But it's been decades since a new class of antibiotics has been developed. Companies like Achaogen and Aradigm, which focused on creating new ones, have shuttered over the past few years. And pharmaceutical giants like Novartis and Allergan have abandoned the effort altogether.

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Drug manufacturers, Fortune said, don't see as much profit in developing new antibiotics as they do other drugs. Many have invested in developing a new antibiotic and failed, she said, and they can make more money by developing drugs people take regularly rather than only when they have an infection. Companies also can't charge as much for antibiotics as they can for other drugs they might develop, and the shelf-life of an antibiotic is relatively short, Fortune said. So if we're going to get new antibiotics, we need to find ways to get companies to prioritise creating them. The United Kingdom is working to create such incentives. The country is investing US$60 million into antibiotic development through an innovation fund, and its National Health Service has developed a subscription-style funding arrangement designed to spur pharmaceutical companies to make new antibiotics. According to that plan, the NHS would pay companies up-front for access to antibiotics, rather than paying for them based on how many pills they sell.

Fighting bacteria with more viruses Outside of developing new antibiotics, a type of virus could be the solution. A category of virus called phages naturally target and kill specific types of bacteria. If you can find the particular phage that kills the bacteria a person is infected with, you could use it to treat their infection. Strathdee has personal experience with this kind of treatment. Her husband was infected by a superbug in 2015, and when antibiotics weren't working, Strathdee reached out to people studying phages and superbugs. By looking through sewage and barnyard waste, where phages are plentiful, and through the phages they had already isolated, the researchers found the phage that matched the bacteria in Strathdee's isolate. They injected him with billions of phages in a phage cocktail, and he made a full recovery. "Not only am I an infectious-disease epidemiologist, but my own family's life was turned upside down and has never been the same as a result of a superbug. And if it caught me off guard, it's going to catch everybody off guard, because the average person doesn't know how big of a problem this is," Strathdee said. The centre she co-founded, IPATH, is now preparing to begin the first National Institutes of Health-funded clinical trial of phage therapy. "What we need is a giant phage library that would be open-source, that could be used to match phages to a specific bacterial infection and used with antibiotics to cure these superbugs," Strathdee said. Experts also stress that the US needs to be better tracking the spread of superbugs, developing antibiotics, researching phage therapy, using existing antibiotics more carefully, and investing much more into tackling this problem before it becomes a larger crisis. Addressing the issue also requires international cooperation, Frieden said. "The bottom line is we need a pluripotent response," Frieden said. "That means sustained funding for health organisations within the US government, including the CDC. That means full support for the World Health Organisation, both in terms of funding and mandate, and that means a better, stronger approach to identifying and fixing the gaps in readiness around the world."

Trump’s Treatments: Regeneron’s Antibodies and Gilead’s Remdesivir Explained By Alex Philippidis and Julianna LeMieux, PhD Source: https://www.genengnews.com/insights/trumps-treatments-regenerons-antibodies-and-gileads-remdesivir-explained/

Oct 05 – President Trump has already received multiple treatments since his COVID-19 diagnosis last week. His treatment began with a leading drug candidate, Regeneron Pharmaceuticals’ two-antibody combination or “cocktail,” REGN-COV2. Within days, his medical team announced that the antiviral remdesivir, from Gilead Sciences, was added to the interventions given to the president. The treatment regimen, which incorporated dexamethasone on Sunday—a steroid typically reserved for serious or more advanced COVID-19 cases—has been rolled out both aggressively and quickly. Referring to the antibody treatment and remdesivir, Peter Hotez, MD, PhD, professor of pediatrics and molecular virology and microbiology at Baylor College of Medicine, noted that the speed is a factor that makes sense to him. He tweeted over the weekend

www.cbrne-terrorism-newsletter.com 125 HZS C2BRNE DIARY – October 2020 that “watch and wait” [is] not an option. He added that in order to maximize the effectiveness of these two interventions, you have to “do it now or not at all.” Hotez added that despite “limited experimental data in humans” for the antibody cocktail, the evidence so far shows how it reduces viral load and shows some evidence of improved clinical outcome. Over the weekend, Trump and his physician, Sean P. Conley, DO, FACEP, sought to reassure Americans that the president was on the mend. Conley initially said Saturday that Trump would stay at Walter Reed National Military Medical Center for an indefinite period. But on Sunday, Brian Thomas Garibaldi, MD, director of the Johns Hopkins Biocontainment Unit, who is consulting with doctors treating Trump, raised hopes of a relatively short hospital stay for the president. Whether these treatments will diminish the president’s battle with COVID-19 remains unknown and a source of unending speculation. Despite the questions that remain regarding this situation, these two treatments have been making their way through the required safety and regulatory hurdles. Indeed, they are two of 19 “front runners” among more than 300 COVID-19 drug and vaccine candidates on GEN’s COVID-19 Drug & Vaccine Tracker. Below are some questions and answers about REGN-COV2 and remdesivir.

REGN-COV2 (Regeneron Pharmaceuticals) Regeneron calls its antibody cocktail REGN-COV2, a combination of two monoclonal antibodies, REGN10933 and REGN10987, that are designed to both treat people with COVID-19 and to prevent SARS-CoV-2 infection.

How is the antibody cocktail designed to work? Both antibodies are designed to bind non-competitively to the receptor-binding domain (RBD) of SARS-CoV-2’s spike protein. According to a paper published August 21 in Science, REGN10933 targets the spike-like loop region on one edge of the ACE2 interface. The fragment antigen-binding region of REGN10933 binds the RBD from the top, where it collides with ACE2, while REGN10987 only binds to the front or the lower left side of the RBD, away from REGN10933, and has little to no overlap with the ACE2 binding site.

How did Regeneron choose these two antibodies for its cocktail? REGN10933 and REGN10987 were the two most potent, non-competing, and virus-neutralizing antibodies selected from thousands produced through Regeneron’s monoclonal antibody discovery platform VelocImmune®, part of the company’s VelociSuite™ technologies. Regeneron has said it has produced two distinct antibody cocktails, an initial cocktail and a backup.

How far advanced is REGN-COV2 in the clinic? REGN-COV2 began its first clinical trial in June , a month later advanced to Phase III, and is now under study in four late-stage clinical trials estimated to recruit at least a combined 11,074 participants: • The Phase II/III portion (NCT04426695) of an adaptive Phase I/II/III trial assessing the safety, tolerability, and efficacy of Regeneron’s antibody cocktail in hospitalized adult patients with COVID-19, with an estimated enrollment of 2,970 participants. • Another Phase II/III portion (NCT04425629) of an adaptive Phase I/II/III trial evaluating the safety, tolerability, and efficacy of Regeneron’s antibody cocktail in ambulatory adult patients with COVID-19, with an estimated enrollment of 2,104 participants. • A portion of the 15,000-patient open-label, Phase III RECOVERY (Randomized Evaluation of COVid-19 thERapY) trial (NCT04381936) that is examining the effectiveness of the cocktail plus standard of care in at least 2,000 hospitalized COVID-19 patients to be chosen at random in the U.K., and comparing that to another 2,000 patients who already receive standard of care alone. • A Phase III trial (NCT04452318) designed to assess REGN-COV2’s ability to prevent infection among uninfected people who have had close exposure to a COVID-19 patient, such as a patient’s housemate. The trial has an estimated enrollment of 2,000 participants.

How much of the antibody cocktail did Trump receive? “He received a single 8 g dose” of REGN-COV2, Conley wrote in a letter made public by the White House on Friday.

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What have clinical trials shown about the 8 g dose of REGN-COV2? The 8 g dose was the higher of two doses studied in a Phase I/II/III trial of REGN-COV2. The 8 g dose showed better results than the 2.4 g low dose and placebo, according to initial data from the first 275 patients Regeneron released on September 29. In that trial, approximately 45% of patients were seropositive, 41% were seronegative, and 14% were categorized as “other” due to unclear or unknown serology status. Among seronegative patients, the mean time-weighted-average change from baseline nasopharyngeal viral load through Day 7 was more among patients receiving the 8 g dose (0.60 log10 copies/mL greater reduction compared to placebo) than the 2.4 g dose (0.51 log10 copies/mL greater reduction). Among all patients, those taking the 8 g dose showed a viral load reduction compared to placebo of 0.51 log10 copies/mL, vs. 0.23 log10 copies/mL for 2.4 g dose patients.

How long has Regeneron been developing an antibody cocktail against SARS-CoV-2? At least since the Biomedical Advanced Research and Development Authority (BARDA) said in February it was expanding upon an earlier partnership agreement with Regeneron to develop “multiple monoclonal antibodies that, individually or in combination, could be used to treat new treatments.” Initially, Regeneron considered another combination, REGN3048 and REGN3051, which completed a 48-patient Phase I trial in MERS-CoV last year (NCT03301090). In April, George D. Yancopoulos, MD, PhD, Regeneron co-founder, president, and CSO, said the company had committed its Industrial Operations and Product Supply manufacturing facility in Rensselaer, NY, toward manufacturing the antibody cocktail, “which on its own could supply hundreds of thousands, if not over the course of time, maybe even on the order of a million or so doses per month.”

Remdesivir (Veklury®, DESREM™, or GS-5734; Gilead Sciences) “An important treatment for hospitalized coronavirus patients,” President Donald Trump said May 1 in announcing FDA emergency use authorization (EUA) for Gilead Sciences’ COVID-19 antiviral drug candidate remdesivir on May 1. “People that are not doing well, people that are sick, people that have this horrible plague that’s set into our country and that we’re getting rid of. And we’re going to be having some really incredible results,” Trump predicted. Five months later, Trump is one of those patients hoping for those really incredible results. Remdesivir is a broad-spectrum antiviral adenosine nucleotide prodrug initially developed to treat Ebola. Last year, remdesivir and a second experimental Ebola treatment were dropped from a clinical trial because they were “much less effective at preventing death” as other candidates.

How is remdesivir designed to work? A monophosphoramidate prodrug of a C-adenosine nucleoside analogue, remdesivir is designed to distribute into cells where it is metabolized to form the pharmacologically active nucleoside triphosphate metabolite. Remdesivir triphosphate acts as an analog of adenosine triphosphate (ATP) and competes with the natural ATP substrate for incorporation into nascent RNA chains by the SARS- CoV-2 RNA-dependent RNA polymerase, which results in delayed chain termination during replication of the viral RNA. According to Gilead, Remdesivir triphosphate is a weak inhibitor of mammalian DNA and RNA polymerases with low potential for mitochondrial toxicity.

How far advanced is remdesivir in the clinic? Remdesivir began its first COVID-19 clinical trial in February in Wuhan, China, a day after Chinese researchers recommended that the antiviral drug candidate remdesivir be assessed in humans as a potential treatment for SARS-CoV-2. Remdesivir advanced to Phase III in July, and is now under study in nine late-stage trials that have recruited more than 13,500 patients: • A Phase III randomized, double-blind, placebo-controlled trial (NCT04501952) designed to assess remdesivir’s safety and efficacy in reducing the rate of hospitalization or death in outpatients with early-stage COVID-19, set to enroll up to 1,230 participants. • The Phase III Adaptive COVID-19 Treatment Trial 1 (ACTT-1; NCT04280705), an adaptive, randomized, double-blind, placebo-controlled trial sponsored by the NIH’s National Institute of Allergy and Infectious Diseases (NIAID) to evaluate the safety and efficacy of remdesivir and other novel therapeutic agents in hospitalized adults diagnosed with COVID-19. 1,062 participants are enrolled. • The Phase III Adaptive COVID-19 Treatment Trial 2 (ACTT-2; NCT04401579), a NIAID-sponsored trial similar to ACTT-1 except that it is comparing the combination of remdesivir and Eli Lilly’s Olumiant® (baricitinib) to remdesivir alone in hospitalized adults. 1,034 participants are enrolled.

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• The Phase III Adaptive COVID-19 Treatment Trial 3 (ACTT-3; NCT04492475), another NIAID-sponsored trial similar to ACTT-1 and ACTT-2, but comparing the combination of interferon beta-1a and remdesivir to remdesivir alone in hospitalized adults. The trial has an estimated enrollment of up to 1,034 participants. • A Phase III randomized trial (SIMPLE; NCT04292730) evaluating the safety and antiviral activity of five-day and 10-day remdesivir regimens compared to standard of care in hospitalized patients with moderate COVID-19. The trial has an actual enrollment of 1,113 participants. • A Phase III randomized trial (SIMPLE-Severe; NCT04292899) assessing the safety and antiviral activity of five-day and 10- day remdesivir regimens compared to standard of care in hospitalized participants with severe COVID-19. The trial has an actual enrollment of 4,891 participants. • The Phase III DisCoVeRy trial (2020-000936-23 and NCT04315948), sponsored by the French Institut National de la Santé et de la Recherche Médicale (INSERM). The multi-center, adaptive, randomized, open trial is comparing remdesivir to AbbVie’s Kaletra, Merck KGaA’s Rebif (interferon-beta-1a), and Sanofi’s Plaquenil (hydroxychloroquine) in hospitalized adults with COVID-19. DisCoVeRy has an estimated enrollment of 3,100 participants. • The Phase III World Health Organization Solidarity Trial comparing remdesivir and AbbVie’s Kaletra® (lopinavir/ritonavir) plus interferon beta-1a to standard of care in hospitalized patients with COVID-19. The trial has recruited more than 10,000 participants in 27 countries. In July, the WHO halted Solidarity’s study of hydroxychloroquine and Kaletra alone after interim results showed they did not reduce mortality. • The Phase II/III CARAVAN trial (NCT04431453), a single-arm, open-label study evaluating the safety, tolerability, and pharmacokinetics (PK) of remdesivir in pediatric participants aged 0 days to < 18 years with COVID-19. The trial has an estimated enrollment of 52 participants.

How much remdesivir did Trump receive? Trump is receiving a five-day course of remdesivir, Conley told reporters Saturday. Remdesivir is typically given in treatment courses of five or 10 days. Patients are dosed intravenously at 200 mg on day 1 followed by 100 mg the other days.

What have clinical trials shown about the five-day course of remdesivir? In August, Gilead researchers published in JAMA data from the Phase III SIMPLE trial (NCT04292730) showing that of 584 patients hospitalized with moderate COVID-19, 197 who were randomized to a 10-day course of remdesivir did not have a statistically significant difference in clinical status compared with the 200 who received standard care at 11 days after the start of treatment. The 199 patients randomized to a five-day course of remdesivir had a statistically significant difference in clinical status compared with standard care, but the difference was of uncertain clinical importance, researchers concluded. In July, Gilead presented additional data from the Phase III SIMPLE-Severe trial showing that remdesivir was associated with an improvement in clinical recovery and a 62% reduction in the risk of mortality compared with standard of care—a finding that Gilead acknowledged requires confirmation in prospective clinical trials. The mortality rate for patients treated with remdesivir was 7.6% at Day 14, compared with 12.5% among patients receiving standard of care. SIMPLE-Severe was a comparative analysis of 312 patients treated in the trial with remdesivir and a real-world retrospective cohort of 818 patients with severe COVID-19 who received standard of care. A total 74.4% of remdesivir-treated patients recovered by Day 14, vs. 59.0% of standard of care patients. And in May, Gilead researchers published a study in The New England Journal of Medicine with preliminary findings from the ACTT trial suggesting that a 10-day course of remdesivir was superior to placebo in treating hospitalized patients with COVID-19. The data showed that patients who were treated with remdesivir showed a 31% faster median time to recovery compared with those who received placebo (11 days compared with 15 days). Kaplan-Meier estimates of mortality by 14 days were 7.1% with remdesivir and 11.9% with placebo.

Should they win approval, how much in sales are REGN-COV2 and remdesivir expected to generate? Morningstar analyst Karen Andersen, CFA, projected last month that REGN-COV2 could generate $6 billion in annual sales in 2021, and remdesivir, $3 billion. Last year, Regeneron generated $7.863 billion in total revenues, while Gilead racked up $22.449 billion. Andersen—one of GEN’s “ Ten Life Science Analysts to Watch in 2020”— added that her firm also expects sales for those and other COVID-19 drugs and vaccines to rapidly decline soon after next year: “We expect most U.S. adults will be vaccinated in the first half of 2021.” On June 3, Geoffrey C. Porges, MBBS, director of therapeutics research and a senior research analyst at SVB Leerink, projected $2 billion in sales for remdesivir this year,

www.cbrne-terrorism-newsletter.com 128 HZS C2BRNE DIARY – October 2020 climbing to $7.7 billion by 2022, then ranging between $6 billion and $7 billion each year after. Porges estimated that remdesivir would be priced at $5,000 per course in the United States, $4,000 per course in Europe, and about $2,000 in other markets. Gilead said in June that the five-day treatment course of remdesivir would be priced at $2,340 for governments of developed countries (six vials at $390 per vial), and $3,120 for U.S. private insurance companies (six vials at $520 per vial).

What is the FDA status of remdesivir and REGN-COV2? Neither drug is approved. Remdesivir received emergency use authorization (EUA) from the FDA on May 1, initially enabling broader use of the antiviral drug through five-day or 10-day treatment in hospitalized patients with severe symptoms of the disease. The FDA on August 28 expanded the EUA to include treating all hospitalized patients with COVID-19. The expanded EUA followed positive results from two Phase III trials: SIMPLE, and the NIH’s NIAID Phase III Adaptive COVID-19 Treatment Trial 1 (ACTT-1; NCT04280705) in hospitalized patients with a range of disease severity. REGN-COV2 has not received EUA. The FDA allows “expanded access” (also called “compassionate use”) allowing patients with an “immediately life-threatening condition or serious disease or condition” to access investigational drugs, biologics, or medical devices for use outside of clinical trials when no comparable or satisfactory alternative therapy options are available. Regeneron said it gave Trump REGN-COV2 under a compassionate use: “All we can say is that they asked to be able to use it, and we were happy to oblige,” Regeneron founder, president, and CEO Leonard S. Schleifer, MD, PhD, told The New York Times.

How close is Trump with the CEOs of Regeneron and Gilead? Regeneron’s Schleifer has known the president casually enough to be called “Lenny” by Trump. Schleifer is a member of Trump National Golf Club in Briarcliff Manor, NY, five miles north of Regeneron’s headquarters in Tarrytown, NY, and listed Trump National as his home golf club on the PGA Tour’s list of amateur participants for this year. Schleifer topped City & State’s 2018 “Westchester Power 50” list of the suburban county’s 50 most influential leaders, but ranked No. 7 a year later when the list was expanded to 100 leaders. In March, Schleifer and Gilead’s chairman and CEO Daniel O’Day were among biopharma executives who met with Trump on March 2 at the White House to discuss their efforts to develop drugs and vaccines against COVID-19. A month later, O’Day and Schleifer were among 200 leaders in 13 specific industries—two of 27 in the “healthcare” industry—who were appointed to his Great American Economic Revival Industry Groups tasked with “work[ing] together with the White House to chart the path forward toward a future of unparalleled American prosperity.” And on May 1, O’Day joined Trump and Vice President Mike Pence in the Oval Office in announcing the FDA’s EUA for remdesivir.

How much does Washington have invested in REGN-COV2 and remdesivir? Through “Operation Warp Speed”—the Trump administration’s effort to fund development, manufacturing, and distribution of COVID- 19 drugs and vaccines—the federal government has committed to Regeneron up to $617.7 million-plus toward REGN-COV2, the largest award being a $450.3 million award to demonstrate large-scale manufacturing of the antibody cocktail. Gilead is not a recipient of Operation Warp Speed funding. However, in June, the U.S. Department of Health and Human Services (HHS) agreed with Gilead and distributor AmerisourceBergen to secure approximately 500,000 commercially available treatment courses of remdesivir for use in U.S. hospitals, at $2,340 per course—a total value of $1.17 billion. The courses were furnished to states (based on COVID-19 hospitalization data), as well as U.S. territories, the Department of Defense, the Department of State, the Veterans Health Administration, the NIH, and the Indian Health Service. Between May 4 and September 30, Gilead also donated approximately 150,000 treatment courses of remdesivir, according to HHS’ Assistant Secretary for Preparedness and Response (ASPR).

What have Regeneron and Gilead said about their manufacturing plans for their treatments? Regeneron agreed to manufacture and supply up to 300,000 treatment doses available from bulk lots of REGN-COV2 under the $450 million Operation Warp Speed contract it was awarded in July by BARDA. Should the FDA grant an EUA or approve REGN- COV2, BARDA would buy those up-to-300,000 doses for treatment of patients. At the time, Regeneron said it had yet to establish the exact number of potential treatment doses (ranging from 70,000 to 300,000) or prevention doses (420,000 to 1.3 million) available from the bulk lots. Regeneron executives have anticipated being able to produce up to 250,000 doses per month next year, through an increase in manufacturing capacity enabled under a partnership with Roche announced in August, and whose value has not been disclosed.

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In reporting second-quarter results in July, Gilead stated: “We currently expect to have manufactured more than two million remdesivir treatment courses by the end of 2020, and several million more treatment courses in 2021.”

What other antibody treatments could Trump have chosen? He could have taken Eli Lilly’s LY-CoV555, a neutralizing antibody targeting SARS-CoV-2 and the lead antibody generated through the pharma giant’s collaboration with AbCellera. In August, Lilly launched the Phase III BLAZE-2 trial, (NCT04497987), which the company is conducting with the NIH’s National Institute of Allergy and Infectious Diseases (NIAID), the COVID-19 Prevention Network, and several long-term care facility networks across the country. BLAZE-2 is designed to study the efficacy and safety of LY-CoV555 in up to 2,400 participants—both residents and staff at U.S. nursing homes and assisted living facilities. Jake Glanville, co-founder and CEO of Distributed Bio, publicly invited Trump to take his company’s antibody cocktail: “We have something that can help the president and his family immediately, as well as an affordable and mass-producible injectable antibody therapy to end the medical crisis in 2021.” Glanville also offered Distributed’s convalescent plasma optimization protocol.

What else has Trump taken for COVID-19 besides REGN-COV2 and remdesivir? In a letter the White House made public on Friday, Conley wrote that the president was also taking famotidine, a Histamine-2 blocker (H2 blocker) sold over the counter as Pepcid®, Vitamin D, and zinc. Trump acknowledged in May that he had taken zinc against COVID-19 in combination with hydroxychloroquine, the anti-malarial drug he has promoted along with azithromycin: “All I can tell you is, so far I seem to be okay,” Trump told reporters on May 18. On Sunday, Conley added that Trump had been given dexamethasone, a corticosteroid used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects. Dexamethasone has been tested in hospitalized patients with COVID-19 in the RECOVERY trial, where it was found to have benefits for critically ill patients. According to preliminary findings shared with the WHO, the treatment was shown to reduce mortality for patients on ventilators by about one third. For patients requiring only oxygen, mortality was cut by about one fifth. The WHO issued guidelines in September recommending use of dexamethasone and other systemic corticosteroids “in patients with severe and critical COVID-19,” and a conditional recommendation not to use those corticosteroids in non-severe COVID-19 patients.

Alex Philippidis specializes in biopharma business news and industry issues as Senior News Editor for GEN / Genetic Engineering & Biotechnology News, sister publication Clinical OMICs, and the parent company for both publications, Mary Ann Liebert, Inc. Julianna LeMieux, PhD, is senior science writer for GEN.

This Overlooked Variable Is the Key to the Pandemic It’s not R. By Zeynep Tufekci Source: https://www.theatlantic.com/health/archive/2020/09/k-overlooked-variable-driving-pandemic/616548/

Oct 01 – There’s something strange about this coronavirus pandemic. Even after months of extensive research by the global scientific community, many questions remain open. Why, for instance, was there such an enormous death toll in northern Italy, but not the rest of the country? Just three contiguous regions in northern Italy have 25,000 of the country’s nearly 36,000 total deaths; just one region, Lombardy, has about 17,000 deaths. Almost all of these were concentrated in the first few months of the outbreak. What happened in Guayaquil, Ecuador, in April, when so many died so quickly that bodies were abandoned in the sidewalks and streets?* Why, in the spring of 2020, did so few cities account for a substantial portion of global deaths, while many others with similar density, weather, age distribution, and travel patterns were spared? What can we really learn from Sweden, hailed as a great success by some because of its low case counts and deaths as the rest of Europe experiences a second wave, and as a big failure by others because it did not lock down and suffered excessive death rates earlier in the pandemic? Why did widespread predictions of catastrophe in Japan not bear out? The baffling examples go on. I’ve heard many explanations for these widely differing trajectories over the past nine months—weather, elderly populations, vitamin D, prior immunity, herd immunity—but none

www.cbrne-terrorism-newsletter.com 130 HZS C2BRNE DIARY – October 2020 of them explains the timing or the scale of these drastic variations. But there is a potential, overlooked way of understanding this pandemic that would help answer these questions, reshuffle many of the current heated arguments, and, crucially, help us get the spread of COVID-19 under control. By now many people have heard about R0—the basic reproductive number of a pathogen, a measure of its contagiousness on average. But unless you’ve been reading scientific journals, you’re less likely to have encountered k, the measure of its dispersion. The definition of k is a mouthful, but it’s simply a way of asking whether a virus spreads in a steady manner or in big bursts, whereby one person infects many, all at once. After nine months of collecting epidemiological data, we know that this is an overdispersed pathogen, meaning that it tends to spread in clusters, but this knowledge has not yet fully entered our way of thinking about the pandemic—or our preventive practices.

The now-famed R0 (pronounced as “r-naught”) is an average measure of a pathogen’s contagiousness, or the mean number of susceptible people expected to become infected after being exposed to a person with the disease. If one ill person infects three others on average, the R0 is three. This parameter has been widely touted as a key factor in understanding how the pandemic operates. News media have produced multiple explainers and visualizations for it. Movies praised for their scientific accuracy on pandemics are lauded for having characters explain the “all-important” R0. Dashboards track its real-time evolution, often referred to as R or Rt, in response to our interventions. (If people are masking and isolating or immunity is rising, a disease can’t spread the same way anymore, hence the difference between R0 and R.) Unfortunately, averages aren’t always useful for understanding the distribution of a phenomenon, especially if it has widely varying behavior. If Amazon’s CEO, Jeff Bezos, walks into a bar with 100 regular people in it, the average wealth in that bar suddenly exceeds $1 billion. If I also walk into that bar, not much will change. Clearly, the average is not that useful a number to understand the distribution of wealth in that bar, or how to change it. Sometimes, the mean is not the message. Meanwhile, if the bar has a person infected with COVID-19, and if it is also poorly ventilated and loud, causing people to speak loudly at close range, almost everyone in the room could potentially be infected—a pattern that’s been observed many times since the pandemic begin, and that is similarly not captured by R. That’s where the dispersion comes in. There are COVID-19 incidents in which a single person likely infected 80 percent or more of the people in the room in just a few hours. But, at other times, COVID-19 can be surprisingly much less contagious. Overdispersion and super-spreading of this virus are found in research across the globe. A growing number of studies estimate that a majority of infected people may not infect a single other person. A recent paper found that in Hong Kong, which

www.cbrne-terrorism-newsletter.com 131 HZS C2BRNE DIARY – October 2020 had extensive testing and contact tracing, about 19 percent of cases were responsible for 80 percent of transmission, while 69 percent of cases did not infect another person. This finding is not rare: Multiple studies from the beginning have suggested that as few as 10 to 20 percent of infected people may be responsible for as much as 80 to 90 percent of transmission, and that many people barely transmit it. This highly skewed, imbalanced distribution means that an early run of bad luck with a few super-spreading events, or clusters, can produce dramatically different outcomes even for otherwise similar countries. Scientists looked globally at known early-introduction events, in which an infected person comes into a country, and found that in some places, such imported cases led to no deaths or known infections, while in others, they sparked sizable outbreaks. Using genomic analysis, researchers in New Zealand looked at more than half the confirmed cases in the country and found a staggering 277 separate introductions in the early months, but also that only 19 percent of introductions led to more than one additional case. A recent review shows that this may even be true in congregate living spaces, such as nursing homes, and that multiple introductions may be necessary before an outbreak takes off. Meanwhile, in Daegu, South Korea, just one woman, dubbed Patient 31, generated more than 5,000 known cases in a megachurch cluster. Unsurprisingly, SARS-CoV, the previous incarnation of SARS-CoV-2 that caused the 2003 SARS outbreak, was also overdispersed in this way: The majority of infected people did not transmit it, but a few super-spreading events caused most of the outbreaks. MERS, another coronavirus cousin of SARS, also appears overdispersed, but luckily, it does not—yet—transmit well among humans. This kind of behavior, alternating between being super infectious and fairly noninfectious, is exactly what k captures, and what focusing solely on R hides. Samuel Scarpino, an assistant professor of epidemiology and complex systems at Northeastern, told me that this has been a huge challenge, especially for health authorities in Western societies, where the pandemic playbook was geared toward the flu—and not without reason, because pandemic flu is a genuine threat. However, influenza does not have the same level of clustering behavior. We can think of disease patterns as leaning deterministic or stochastic: In the former, an outbreak’s distribution is more linear and predictable; in the latter, randomness plays a much larger role and predictions are hard, if not impossible, to make. In deterministic trajectories, we expect what happened yesterday to give us a good sense of what to expect tomorrow. Stochastic phenomena, however, don’t operate like that—the same inputs don’t always produce the same outputs, and things can tip over quickly from one state to the other. As Scarpino told me, “Diseases like the flu are pretty nearly deterministic and R0 (while flawed) paints about the right picture (nearly impossible to stop until there’s a vaccine).” That’s not necessarily the case with super-spreading diseases. Nature and society are replete with such imbalanced phenomena, some of which are said to work according to the Pareto principle, named after the sociologist Vilfredo Pareto. Pareto’s insight is sometimes called the 80/20 principle—80 percent of outcomes of interest are caused by 20 percent of inputs—though the numbers don’t have to be that strict. Rather, the Pareto principle means that a small number of events or people are responsible for the majority of consequences. This will come as no surprise to anyone who has worked in the service sector, for example, where a small group of problem customers can create almost all the extra work. In cases like those, booting just those customers from the business or giving them a hefty discount may solve the problem, but if the complaints are evenly distributed, different strategies will be necessary. Similarly, focusing on the R alone, or using a flu-pandemic playbook, won’t necessarily work well for an overdispersed pandemic. Hitoshi Oshitani, a member of the National COVID-19 Cluster Taskforce at Japan’s Ministry of Health, Labour and Welfare and a professor at Tohoku University who told me that Japan focused on the overdispersion impact from early on, likens his country’s approach to looking at a forest and trying to find the clusters, not the trees. Meanwhile, he believes, the Western world was getting distracted by the trees, and got lost among them. To fight a super-spreading disease effectively, policy makers need to figure out why super-spreading happens, and they need to understand how it affects everything, including our contact-tracing methods and our testing regimes.

There may be many different reasons a pathogen super-spreads. Yellow fever spreads mainly via the mosquito Aedes aegypti, but until the insect’s role was discovered, its transmission pattern bedeviled many scientists. Tuberculosis was thought to be spread by close-range droplets until an ingenious set of experiments proved that it was airborne. Much is still unknown about the super- spreading of SARS-CoV-2. It might be that some people are super-emitters of the virus, in that they spread it a lot more than other people. Like other diseases, contact patterns surely play a part: A politician on the campaign trail or a student in a college dorm is very different in how many people they could potentially expose compared with, say, an elderly person living in a small household. However, looking at nine months of epidemiological data, we have important clues to some of the factors. In study after study, we see that super-spreading clusters of COVID-19 almost overwhelmingly occur in poorly ventilated, indoor environments where many people

www.cbrne-terrorism-newsletter.com 132 HZS C2BRNE DIARY – October 2020 congregate over time—weddings, churches, choirs, gyms, funerals, restaurants, and such—especially when there is loud talking or singing without masks. For super-spreading events to occur, multiple things have to be happening at the same time, and the risk is not equal in every setting and activity, Muge Cevik, a clinical lecturer in infectious diseases and medical virology at the University of St. Andrews and a co-author of a recent extensive review of transmission conditions for COVID-19, told me. Cevik identifies “prolonged contact, poor ventilation, [a] highly infectious person, [and] crowding” as the key elements for a super- spreader event. Super-spreading can also occur indoors beyond the six-feet guideline, because SARS-CoV-2, the pathogen causing COVID-19, can travel through the air and accumulate, especially if ventilation is poor. Given that some people infect others before they show symptoms, or when they have very mild or even no symptoms, it’s not always possible to know if we are highly infectious ourselves. We don’t even know if there are more factors yet to be discovered that influence super-spreading. But we don’t need to know all the sufficient factors that go into a super-spreading event to avoid what seems to be a necessary condition most of the time: many people, especially in a poorly ventilated indoor setting, and especially not wearing masks. As Natalie Dean, a biostatistician at the University of Florida, told me, given the huge numbers associated with these clusters, targeting them would be very effective in getting our transmission numbers down. Overdispersion should also inform our contact-tracing efforts. In fact, we may need to turn them upside down. Right now, many states and nations engage in what is called forward or prospective contact tracing. Once an infected person is identified, we try to find out with whom they interacted afterward so that we can warn, test, isolate, and quarantine these potential exposures. But that’s not the only way to trace contacts. And, because of overdispersion, it’s not necessarily where the most bang for the buck lies. Instead, in many cases, we should try to work backwards to see who first infected the subject. Because of overdispersion, most people will have been infected by someone who also infected other people, because only a small percentage of people infect many at a time, whereas most infect zero or maybe one person. As Adam Kucharski, an epidemiologist and the author of the book The Rules of Contagion, explained to me, if we can use retrospective contact tracing to find the person who infected our patient, and then trace the forward contacts of the infecting person, we are generally going to find a lot more cases compared with forward-tracing contacts of the infected patient, which will merely identify potential exposures, many of which will not happen anyway, because most transmission chains die out on their own. The reason for backward tracing’s importance is similar to what the sociologist Scott L. Feld called the friendship paradox: Your friends are, on average, going to have more friends than you. (Sorry!) It’s straightforward once you take the network-level view. Friendships are not distributed equally; some people have a lot of friends, and your friend circle is more likely to include those social butterflies, because how could it not? They friended you and others. And those social butterflies will drive up the average number of friends that your friends have compared with you, a regular person. (Of course, this will not hold for the social butterflies themselves, but overdispersion means that there are much fewer of them.) Similarly, the infectious person who is transmitting the disease is like the pandemic social butterfly: The average number of people they infect will be much higher than most of the population, who will transmit the disease much less frequently. Indeed, as Kucharski and his co-authors show mathematically, overdispersion means that “forward tracing alone can, on average, identify at most the mean number of secondary infections (i.e. R)”; in contrast, “backward tracing increases this maximum number of traceable individuals by a factor of 2-3, as index cases are more likely to come from clusters than a case is to generate a cluster.” Even in an overdispersed pandemic, it’s not pointless to do forward tracing to be able to warn and test people, if there are extra resources and testing capacity. But it doesn’t make sense to do forward tracing while not devoting enough resources to backward tracing and finding clusters, which cause so much damage. Another significant consequence of overdispersion is that it highlights the importance of certain kinds of rapid, cheap tests. Consider the current dominant model of test and trace. In many places, health authorities try to trace and find forward contacts of an infected person: everyone they were in touch with since getting infected. They then try to test all of them with expensive, slow, but highly accurate PCR (polymerase chain reaction) tests. But that’s not necessarily the best way when clusters are so important in spreading the disease. PCR tests identify RNA segments of the coronavirus in samples from nasal swabs—like looking for its signature. Such diagnostic tests are measured on two different dimensions: Are they good at identifying people who are not infected (specificity), and are they good at identifying people who are infected (sensitivity)? PCR tests are highly accurate for both dimensions. However, PCR tests are also slow and expensive, and they require a long, uncomfortable swab up the nose at a medical facility. The slow processing times means that people don’t get timely information when they need it. Worse, PCR tests are so responsive that they can find tiny remnants of coronavirus signatures long after someone has stopped being contagious, which can cause unnecessary quarantines. Meanwhile, researchers have shown that rapid tests that are very accurate for identifying people who do not have the disease, but not as good at identifying infected

www.cbrne-terrorism-newsletter.com 133 HZS C2BRNE DIARY – October 2020 individuals, can help us contain this pandemic. As Dylan Morris, a doctoral candidate in ecology and evolutionary biology at Princeton, told me, cheap, low-sensitivity tests can help mitigate a pandemic even if it is not overdispersed, but they are particularly valuable for cluster identification during an overdispersed one. This is especially helpful because some of these tests can be administered via saliva and other less-invasive methods, and be distributed outside medical facilities. In an overdispersed regime, identifying transmission events (someone infected someone else) is more important than identifying infected individuals. Consider an infected person and their 20 forward contacts—people they met since they got infected. Let’s say we test 10 of them with a cheap, rapid test and get our results back in an hour or two. This isn’t a great way to determine exactly who is sick out of that 10, because our test will miss some positives, but that’s fine for our purposes. If everyone is negative, we can act as if nobody is infected, because the test is pretty good at finding negatives. However, the moment we find a few transmissions, we know we may have a super-spreader event, and we can tell all 20 people to assume they are positive and to self-isolate—if there are one or two transmissions, there are likely more, exactly because of the clustering behavior. Depending on age and other factors, we can test those people individually using PCR tests, which can pinpoint who is infected, or ask them all to wait it out. Scarpino told me that overdispersion also enhances the utility of other aggregate methods, such as wastewater testing, especially in congregate settings like dorms or nursing homes, allowing us to detect clusters without testing everyone. Wastewater testing also has low sensitivity; it may miss positives if too few people are infected, but that’s fine for population-screening purposes. If the wastewater testing is signaling that there are likely no infections, we do not need to test everyone to find every last potential case. However, the moment we see signs of a cluster, we can rapidly isolate everyone, again while awaiting further individualized testing via PCR tests, depending on the situation. Unfortunately, until recently, many such cheap tests had been held up by regulatory agencies in the United States, partly because they were concerned with their relative lack of accuracy in identifying positive cases compared with PCR tests—a worry that missed their population-level usefulness for this particular overdispersed pathogen.

To return to the mysteries of this pandemic, what did happen early on to cause such drastically different trajectories in otherwise similar places? Why haven’t our usual analytic tools—case studies, multi-country comparisons—given us better answers? It’s not intellectually satisfying, but because of the overdispersion and its stochasticity, there may not be an explanation beyond that the worst-hit regions, at least initially, simply had a few unlucky early super-spreading events. It wasn’t just pure luck: Dense populations, older citizens, and congregate living, for example, made cities around the world more susceptible to outbreaks compared with rural, less dense places and those with younger populations, less mass transit, or healthier citizenry. But why Daegu in February and not Seoul, despite the two cities being in the same country, under the same government, people, weather, and more? As frustrating at it may be, sometimes, the answer is merely where Patient 31 and the megachurch she attended happened to be. Overdispersion makes it harder for us to absorb lessons from the world, because it interferes with how we ordinarily think about cause and effect. For example, it means that events that result in spreading and non-spreading of the virus are asymmetric in their ability to inform us. Take the highly publicized case in Springfield, Missouri, in which two infected hairstylists, both of whom wore masks, continued to work with clients while symptomatic. It turns out that no apparent infections were found among the 139 exposed clients (67 were directly tested; the rest did not report getting sick). While there is a lot of evidence that masks are crucial in dampening transmission, that event alone wouldn’t tell us if masks work. In contrast, studying transmission, the rarer event, can be quite informative. Had those two hairstylists transmitted the virus to large numbers of people despite everyone wearing masks, it would be important evidence that, perhaps, masks aren’t useful in preventing super-spreading. Comparisons, too, give us less information compared with phenomena for which input and output are more tightly coupled. When that’s the case, we can check for the presence of a factor (say, sunshine or Vitamin D) and see if it correlates with a consequence (infection rate). But that’s much harder when the consequence can vary widely depending on a few strokes of luck, the way that the wrong person was in the wrong place sometime in mid-February in South Korea. That’s one reason multi-country comparisons have struggled to identify dynamics that sufficiently explain the trajectories of different places. Once we recognize super-spreading as a key lever, countries that look as if they were too relaxed in some aspects appear very different, and our usual polarized debates about the pandemic are scrambled, too. Take Sweden, an alleged example of the great success or the terrible failure of herd immunity without lockdowns, depending on whom you ask. In reality, although Sweden joins many other countries in failing to protect elderly populations in congregate-living facilities, its measures that target super-spreading have been stricter than many other European countries. Although it did not have a complete lockdown, as Kucharski pointed out to me, Sweden imposed a 50-person limit on indoor

www.cbrne-terrorism-newsletter.com 134 HZS C2BRNE DIARY – October 2020 gatherings in March, and did not remove the cap even as many other European countries eased such restrictions after beating back the first wave. (Many are once again restricting gathering sizes after seeing a resurgence.) Plus, the country has a small household size and fewer multigenerational households compared with most of Europe, which further limits transmission and cluster possibilities. It kept schools fully open without distancing or masks, but only for children under 16, who are unlikely to be super- spreaders of this disease. Both transmission and illness risks go up with age, and Sweden went all online for higher-risk high-school and university students—the opposite of what we did in the United States. It also encouraged social-distancing, and closed down indoor places that failed to observe the rules. From an overdispersion and super-spreading point of view, Sweden would not necessarily be classified as among the laxest countries, but nor is it the most strict. It simply doesn’t deserve this oversize place in our debates assessing different strategies.

Although overdispersion makes some usual methods of studying causal connections harder, we can study failures to understand which conditions turn bad luck into catastrophes. We can also study sustained success, because bad luck will eventually hit everyone, and the response matters. The most informative case studies may well be those who had terrible luck initially, like South Korea, and yet managed to bring about significant suppression. In contrast, Europe was widely praised for its opening early on, but that was premature; many countries there are now experiencing widespread rises in cases and look similar to the United States in some measures. In fact, Europe’s achieving a measure of success this summer and relaxing, including opening up indoor events with larger numbers, is instructive in another important aspect of managing an overdispersed pathogen: Compared with a steadier regime, success in a stochastic scenario can be more fragile than it looks. Once a country has too many outbreaks, it’s almost as if the pandemic switches into “flu mode,” as Scarpino put it, meaning high, sustained levels of community spread even though a majority of infected people may not be transmitting onward. Scarpino explained that barring truly drastic measures, once in that widespread and elevated mode, COVID-19 can keep spreading because of the sheer number of chains already out there. Plus, the overwhelming numbers may eventually spark more clusters, further worsening the situation. As Kucharski put it, a relatively quiet period can hide how quickly things can tip over into large outbreaks and how a few chained amplification events can rapidly turn a seemingly under-control situation into a disaster. We’re often told that if Rt, the real-time measure of the average spread, is above one, the pandemic is growing, and that below one, it’s dying out. That may be true for an epidemic that is not overdispersed, and while an Rt below one is certainly good, it’s misleading to take too much comfort from a low Rt when just a few events can reignite massive numbers. No country should forget South Korea’s Patient 31. That said, overdispersion is also a cause for hope, as South Korea’s aggressive and successful response to that outbreak—with a massive testing, tracing, and isolating regime—shows. Since then, South Korea has also been practicing sustained vigilance, and has demonstrated the importance of backward tracing. When a series of clusters linked to nightclubs broke out in Seoul recently, health authorities aggressively traced and tested tens of thousands of people linked to the venues, regardless of their interactions with the index case, six feet apart or not—a sensible response, given that we know the pathogen is airborne. Perhaps one of the most interesting cases has been Japan, a country with middling luck that got hit early on and followed what appeared to be an unconventional model, not deploying mass testing and never fully shutting down. By the end of March, influential economists were publishing reports with dire warnings, predicting overloads in the hospital system and huge spikes in deaths. The predicted catastrophe never came to be, however, and although the country faced some future waves, there was never a large spike in deaths despite its aging population, uninterrupted use of mass transportation, dense cities, and lack of a formal lockdown. It’s not that Japan was better situated than the United States in the beginning. Similar to the U.S. and Europe, Oshitani told me, Japan did not initially have the PCR capacity to do widespread testing. Nor could it impose a full lockdown or strict stay-at-home orders; even if that had been desirable, it would not have been legally possible in Japan. Oshitani told me that in Japan, they had noticed the overdispersion characteristics of COVID-19 as early as February, and thus created a strategy focusing mostly on cluster-busting, which tries to prevent one cluster from igniting another. Oshitani said he believes that “the chain of transmission cannot be sustained without a chain of clusters or a megacluster.” Japan thus carried out a cluster-busting approach, including undertaking aggressive backward tracing to uncover clusters. Japan also focused on ventilation, counseling its population to avoid places where the three C’s come together—crowds in closed spaces in close contact, especially if there’s talking or singing—bringing together the science of overdispersion with the recognition of airborne aerosol transmission, as well as presymptomatic and asymptomatic transmission. Oshitani contrasts the Japanese strategy, nailing almost every important feature of the pandemic early on, with the Western response, trying to eliminate the disease “one by one”

www.cbrne-terrorism-newsletter.com 135 HZS C2BRNE DIARY – October 2020 when that’s not necessarily the main way it spreads. Indeed, Japan got its cases down, but kept up its vigilance: When the government started noticing an uptick in community cases, it initiated a state of emergency in April and tried hard to incentivize the kinds of businesses that could lead to super-spreading events, such as theaters, music venues, and sports stadiums, to close down temporarily. Now schools are back in session in person, and even stadiums are open—but without chanting. It’s not always the restrictiveness of the rules, but whether they target the right dangers. As Morris put it, “Japan’s commitment to ‘cluster-busting’ allowed it to achieve impressive mitigation with judiciously chosen restrictions. Countries that have ignored super-spreading have risked getting the worst of both worlds: burdensome restrictions that fail to achieve substantial mitigation. The U.K.’s recent decision to limit outdoor gatherings to six people while allowing pubs and bars to remain open is just one of many such examples.” Could we get back to a much more normal life by focusing on limiting the conditions for super-spreading events, aggressively engaging in cluster-busting, and deploying cheap, rapid mass tests—that is, once we get our case numbers down to low enough numbers to carry out such a strategy? (Many places with low community transmission could start immediately.) Once we look for and see the forest, it becomes easier to find our way out.

* This article originally stated that, in April, coronavirus deaths spiked in Quito, Ecuador. In fact, they spiked in Guayaquil, Ecuador.

Zeynep Tufekci is a contributing writer at The Atlantic and an associate professor at the University of North Carolina. She studies the interaction between digital technology, artificial intelligence, and society.

Coronavirus: Thresholds for Effective Herd Immunity Could be Lower Than Predicted – Here’s Why By Pieter Trapman Source: http://www.homelandsecuritynewswire.com/dr20201005-coronavirus-thresholds-for-effective-herd-immunity-could-be- lower-than-predicted-here-s-why

Oct 05 – Basic models for COVID-19 suggest herd immunity is achieved when 60 percent of people are immune. This is because in a population where everyone is susceptible to the coronavirus, an infected person is estimated to infect on average an additional 2.5 people. Yet if 60 percent of those theoretical 2.5 people are immune, then only one new infection can take place, and the outbreak cannot grow. This is based on a very simple model, though. It assumes that everyone in the population mixes to the same degree and at random. It’s unrealistic. In our research, we tried to reflect some of the diversity of behavior found in human populations to show what effect it might have on reaching herd immunity. We looked at two factors that influence the degree to which people mix with each other. The first was sociability. Those who are more socially active are more likely to be infected in the early stages of an epidemic. This means that over time, naturally acquired immunity tends to be concentrated in those who make lots of social connections, while susceptibility to the disease – and the capability of spreading it – tends to be over-represented among people who make fewer connections. As we demonstrated, this can affect when the herd immunity threshold is reached. We created an illustrative model in which 25 percent of people socialize half as much as the average, 50 percent socialize an average amount, and the remaining 25 percent socialize twice as much as average. When you have these different groups mixing at these different rates, the model predicts that the herd immunity threshold will be considerably lower: 46.3 percent instead of 60 percent. If more differences between people are considered, the point at which herd immunity is reached through natural infection decreases even further. With this in mind, we considered the effect of age on social mixing. People in one age group don’t mix equally with people across other age groups; across a population, socialization follows certain trends. To roughly model this, we split the population into six age groups, and then estimated the amount of contact between them using data from a previous study on social contacts. We found that accounting for age-specific mixing trends, together with different sociability levels, lowered the herd immunity threshold a little further, to 43 percent.

What Does This Mean? The first important thing to say is that our estimates should be interpreted only as a demonstration of how differences in behavior can affect herd immunity. These figures aren’t

www.cbrne-terrorism-newsletter.com 136 HZS C2BRNE DIARY – October 2020 exact values, or even best estimates. The activity levels and contact rates between age groups that we used in the model were simply illustrative. The second thing to note is that we’ve only accounted for two types of variation across the population. More realistic models would be more complex, including many other factors. For example, large household sizes, school and work environments, and metropolitan living all create higher rates of person-to-person contact. In such places a greater proportion of people will get infected, and infection and immunity will be more concentrated among highly active and connected individuals. Finally, for our model we’ve assumed that immunity doesn’t decrease over time and that it offers 100 percent protection. Neither of these things are necessarily true. But what our work does seem to suggest is that most forms of variation across a population will decrease the point at which herd immunity is reached through natural infection. This means that it could be reached at a lower human cost than previously expected. In countries or areas that have already been heavily hit by the virus, herd immunity might already be close. In such places, stopping the spread of the disease might therefore only require getting people to adhere to relatively mild restrictions on social behavior. Some words of warning are needed though. Even if the threshold is lower, reaching herd immunity through natural infection will still require a lot of people to get infected. Though lower than initially thought, the human cost would still be very high. The city of Manaus in Brazil may be the first in the world to have reached herd immunity, but one in every 350 people infected with the virus there has died, amounting to around 2,500 deaths in total. Finally, while variation across the population generally decreases the overall level of immunity needed, among the most active people, the fraction that needs to be infected to reach herd immunity will be more than 60 percent.

Pieter Trapman is Senior Lecturer in Mathematics, Stockholm University.

Stats Hold a Surprise: Lockdowns May Have Had Little Effect on COVID-19 Spread Source: https://www.nationalreview.com/2020/10/stats-hold-a-surprise-lockdowns-may-have-had-little-effect-on-covid-19-spread/

A man walks dogs across a nearly empty 5th Avenue during the COVID-19 coronavirus outbreak in Manhattan, May 11, 2020. (Mike Segar/Reuters) Data suggest mandatory lockdowns exacted a great cost, with a questionable effect on transmission.

Oct 04 – In 1932, Supreme Court justice Louis Brandeis famously called the states “laboratories of democracy.” Different states can test out different policies, and they can learn from each other. That proved true in 2020. Governors in different states responded to the COVID-19 pandemic at different times and in different ways. Some states, such as

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California, ordered sweeping shutdowns. Others, such as Florida, took a more targeted approach. Still others, such as South Dakota, dispensed information but had no lockdowns at all. As a result, we can now compare outcomes in different states, to test the question no one wants to ask: Did the lockdowns make a difference? If lockdowns really altered the course of this pandemic, then coronavirus case counts should have clearly dropped whenever and wherever lockdowns took place. The effect should have been obvious, though with a time lag. It takes time for new coronavirus infections to be officially counted, so we would expect the numbers to plummet as soon as the waiting time was over.

Daily confirmed COVID-19 cases for the United States and thirteen U.S. states (logarithmic plots) up to May 20, 2020. Dashed line segments (drawn by hand) show the initial steep increase with gray circles marking the first visual downward change of slope. Locks mark the lockdown dates, and 10-day calendars show where lockdowns would have had visible effects. Open locks mark when lockdowns ended for Florida and Georgia, two of the first wave of states to emerge from lockdown. The vertical lines mark the dates when deaths attributed to the coronavirus reached five per million people in the population. Gaps in curves are the result of unreported data. Information sources: Doug Axe, William Briggs, and Jay W. Richards, The Price of Panic: How the Tyranny of Experts Turned a Pandemic into a Catastrophe;

How long? New infections should drop on day one and be noticed about ten or eleven days from the beginning of the lockdown. By day six, the number of people with first symptoms of infection should plummet (six days is the average time for symptoms to appear). By day nine or ten, far fewer people would be heading to doctors with worsening symptoms. If COVID-19 tests were performed right away, we would expect the positives to drop clearly on day ten or eleven (assuming quick turnarounds on tests). To judge from the evidence, the answer is clear: Mandated lockdowns had little effect on the spread of the coronavirus. The charts below show the daily case curves for the United States as a whole and for thirteen U.S. states. As in almost every country, we consistently see a steep climb as the virus spreads, followed by a transition (marked by the gray circles) to a flatter curve. At some point, the curves always slope downward, though this wasn’t obvious for all states until the summer.

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Lockdowns Not the Cause The lockdowns can’t be the cause of these transitions. In the first place, the transition happened even in places without lockdown orders (see Iowa and Arkansas). And where there were lockdowns, the transitions tended to occur well before the lockdowns could have had any serious effect. The only possible exceptions are California, which on March 19 became the first state to officially lock down, and Connecticut, which followed four days later. Even in these places, though, the downward transitions probably started before the lockdowns could have altered the curves. The reason is that a one-day turnaround for COVID-19 test results probably wasn’t met in either state. On March 30, the Los Angeles Times reported the turnaround time to be eight days. That would make the delay from infection to confirmation not the 10 we assumed, but more like 17 days (6 for symptoms to appear, 3 for them to develop, and 8 for test processing). In early April, the Hartford Courant reported similar problems with delayed test results in Connecticut. What’s more, there’s no decisive drop on the dates when lockdowns should have changed the course of the curves. Instead, the curves gradually bend downward for reasons that predate the lockdowns, with no clear changes ten days later. Lockdown partisans might say that the curves would have been higher after the ten-day mark without the lockdown. While we can’t redo history to prove them wrong, the point is that the sudden and dramatic changes we should see if they were right aren’t there. If we showed people these curves without any markings, they would not be able to discern when or even if lockdowns went into effect. The vertical lines mark the date when the number of deaths attributed to the coronavirus reached five per million people in the population. This is probably the best way to mark similar extents of viral progress in each state, since we don’t know how many total cases there were. The curves usually start to bend somewhere around the same death toll (roughly five per million people), which suggests that the approach of herd immunity caused the bends. In other words, we see in this data not only a lack of evidence that lockdowns caused the curves to bend, but also evidence of the very early stages of herd immunity. In fact, a May 18 column in the New York Times argued that coronavirus cases in New York City probably peaked before the state lockdown began on March 22. Though that newspaper is not known for taking a critical stance on lockdowns, this point implies that the spread was slowing before the mayor and governor even ordered the lockdown. Something caused this overall decline. It couldn’t have been lockdowns, which weren’t maintained (or heeded) in full force through June. At the moment, we can only speculate. But if this virus is like others, its decline is likely attributable to some mix of changing seasons and the gradual onset of herd immunity. Another factor, of course, could be the widespread use of masks as the year progressed. The evidence suggests, then, that the sweeping, mandated lockdowns that followed voluntary responses exacted a great cost, with little effect on transmission. We can’t change the past, but we should avoid making the same mistake again.

U.S. COVID Deaths May Be Underestimated by 36 Percent Source: http://www.homelandsecuritynewswire.com/dr20201006-u-s-covid-deaths-may-be-underestimated-by-36-percent

Oct 06 – More than 200,000 people in the United States have now died from COVID-19. But the death toll of the U.S. epidemic is likely much higher, according to a new, first-of-its-kind study from researchers at the University of Pennsylvania, Boston University, and the Robert Wood Johnson Foundation. Available as a pre-print on medRxiv ahead of peer-reviewed publication, the study estimates the number of “excess deaths,” those that occurred from February through September 2020 above what would be expected in a normal year. For every 100 excess deaths directly attributed to COVID-19, there were another 36 excess deaths. This means 26 percent of all excess deaths were not directly attributed to COVID. The research team, which included Penn demographers Samuel Preston and Irma Elo, found more of these additional deaths in counties with greater income inequality, more non-Hispanic Black residents, less homeownership, and high-population density, indicating a pattern related to socioeconomic disadvantage and structural racism. “Excess deaths can provide a more robust measure of the total mortality effects of the pandemic compared to direct tallies of COVID deaths,” says study lead author Andrew Stokes, an assistant professor of global health at BU. “Excess deaths include COVID deaths that were ascribed to other causes, as well as the indirect consequences of the pandemic on society.” These could include fear of going to the hospital for another condition or any number of issues caused or exacerbated by COVID’s economic and mental health impacts. Stokes and colleagues analyzed county-level mortality data from the National Center for Health Statistics for 1,021 counties with 10 or more COVID deaths from Feb. 1 to Sept. 23. Previous studies have estimated excess deaths at the national and state levels, but this is

www.cbrne-terrorism-newsletter.com 139 HZS C2BRNE DIARY – October 2020 the first to examine the question at the county level, allowing the researchers to look at how patterns of excess deaths vary by demographic and structural factors. The researchers used Centers for Disease Control and Prevention data from 2013 to 2018 to estimate how many deaths each county would have been expected to have during this period if not for the COVID pandemic (as death rates change from year to year). In total, the 1,000-plus counties experienced 249,167 excess deaths, or those beyond what was expected given historical patterns. Of those, 26 percent, or 65,481 death certificates, did not directly assign COVID as the cause of death. The other 183,686 did. In other words, the number of deaths directly assigned to COVID should be inflated by 36 percent to estimate the total number of deaths for which COVID is responsible. “Counties with high levels of COVID-19 mortality also had exceptionally high levels of mortality in 2020 from other causes of death,” says Preston, study senior author and a Penn professor of sociology. “This result suggests that the epidemic is responsible for many more deaths than are attributed to COVID-19 alone.” While most counties saw more deaths than would have been expected in a normal year, some saw fewer. The researchers analyzed the relationship between these excess deaths and differences in demographics and structural factors using U.S. Census data, finding that communities already known to have been most harmed by COVID-19 have lost even more lives to the pandemic than official numbers show. “Our results focus important attention on the disparate impact of the COVID-19 pandemic on low-income and minority communities,” says Elo. “These groups have historically experienced high death rates, which are now further exacerbated by the current pandemic.”

COVID-19 Anti-Vaxxers Use the Same Arguments from 135 Years Ago By Paula Larsson Source: http://www.homelandsecuritynewswire.com/dr20201006-covid19-antivaxxers-use-the-same-arguments-from-135-years-ago

Oct 06 – As we get closer to an effective vaccine for COVID-19, we should expect to see a renewed push of disinformation and vocal resistance from the anti-vaccination movement. Over the past year, seemingly endless conspiracy theories and misinformation campaigns have gained traction online amidst rising COVID-19 infection rates worldwide. Looking at the history of these movements can help us understand why they can be so effective at capturing a popular following. As a historian of medicine, it’s become clear from researching the history of vaccines that those who promote anti-vaccination consistently use a standard set of strategies. Although it can be hard to see patterns of argument in the modern context, looking back at a historical instance of epidemic and misinformation provides a useful case study for revealing today’s recurring anti- vaccination strategies. One popular pamphlet published in 1885 during the smallpox epidemic in Montréal is a great example. Over a century later, we have the benefit of living in a world that has eradicated smallpox using a vaccine. Yet in the past, smallpox vaccination was hotly contested, despite the evidence in favour of its effectiveness. Published by a leading anti-vaccinationist, Dr. Alexander M. Ross, this pamphlet was widely circulated during the smallpox epidemic of 1885 in Montréal, as public health officials were seeking to increase vaccination coverage. Ross seized on the opportunity of increased health measures to gain authority, notoriety and personal fame. He painted himself the hero of his own story, the “only doctor; who had dared to doubt the fetish” of vaccination. Despite this, it was discovered that he had been recently vaccinated during the epidemic, a fact that was gleefully reported by the major newspapers at the time. His pamphlet serves as a prime illustration of the strategies used by anti-vaccinationists — both then and now. These arguments are not new and have changed little over time. Learning to recognize their repackaging in modern form can help with effectively combating their power.

Minimize the Threat of a Disease Ross and his anti-vaccination associates were quick to dismiss the threat of smallpox. Despite mortality rates between 30 and 40 per cent, and the extreme contagiousness of the disease, it was common for anti-vaccinationists to claim that smallpox was only a minor threat to a population. Ross decried the “senseless panic” caused by health officials and physicians over the epidemic, claiming that smallpox was not, in fact, epidemic, and that the city had “very few cases.” Official numbers for the epidemic would eventually rise to 9,600 reported cases with 3,234 deaths — nearly two per cent of Montréal’s population at the time. An additional 10,000 cases were recorded in the province of Québec, but historians believe the actual numbers were likely

www.cbrne-terrorism-newsletter.com 140 HZS C2BRNE DIARY – October 2020 much higher. These numbers and the story of this epidemic have been narrated by historian Michael Bliss in his non-fiction account, Plague: A Story of Smallpox in Montreal. The minimization of threat is a common tactic in contemporary debates as well. Many who promote the anti-vaccination agenda claim vaccines to be more dangerous than the disease.

Claim Vaccine Causes Illness, Is Ineffective, or Both Although modern arguments have focused on the false claim that vaccines cause autism, historic arguments were much more varied in their allegations of infections from the smallpox vaccine. The anti-vaccinationists of the past claimed that vaccination caused a full spectrum of diseases, from smallpox itself to syphilis, typhoid, tuberculosis, cholera and “blood-poisoning.” These claims were not always groundless, but their risks were consistently exaggerated. Cases had been known to occur of secondary disease transmission due to poor practice. Some physicians used arm-to-arm vaccination — meaning they would use the same instrument to vaccinate a whole line of people — or used vaccine prepared from a human source rather than a bovine source. The lack of sterile cleaning between operations or the use of vaccine prepared from an infected person could lead to rare cases of secondary disease transmissions. The discovery of such transmissions (years earlier) sparked some of the first regulations around vaccine preparation and administration, and generated a keen concern within the medical community about vaccine safety — a concern which has continued to be a mainstay of vaccine production to this day.

Declare Vaccination Is Part of a Larger Conspiracy Ross’s pamphlet was adamant about the role of both the press and the medical profession in stoking fears over infection as part of a “mad” campaign for gaining money. Much like today, epidemics created opportunities for both employment and research in the medical field. Yet this employment was painted as an unethical exploitation of the poor, worth “one million pounds sterling” to the profession, rather than an effort in combating the suffering and death of thousands. Additionally, public health measures were depicted as an assault on personal rights and an overreach of government power. “Talk no longer of Russian Tyranny,” Ross declared, for there was “none so formidable” as the city health officials. His arguments are still echoed over a century later in the current pandemic, as we see continued support behind the belief in a conspiracy to limit freedoms (among other, more extreme, conspiracy theories).

Use Alternative Authorities That Legitimize Your Argument Last but not least is an appeal to authorities that help legitimize the anti-vaccination argument. The modern anti-vaxxer movement has an abundance of these, led by Andrew Wakefield, the now discredited former physician who originally published the fraudulent study linking the MMR (measles, mumps, rubella) vaccine to autism. But the anti-vaccination movement has had a long tradition of promoting the words of “experts” who support their narrative. In the 19th century, vaccination debates often brought in a similar small circle of medical men who spoke against vaccination, calling it a “filthy” and “evil” practice. Although their arguments were refuted by many in the medical community, they gained a lasting mantle of prestige amongst anti-vaccinationists as the authoritative voices that offered the “proof” that was needed. This is not an exhaustive list of anti-vaccination strategies — either historical or contemporary. There have always been individuals who capitalize on medical crises to push their own agenda, and in the modern age of digital media, strategies of misinformation have evolved and expanded. Much like Ross, the leaders of these movements gain social power by painting themselves as lone crusaders. As we get closer to a worldwide distribution of COVID-19 vaccine, we can expect to see more and more such crusaders publishing arguments against vaccination. Breaking down patterns of arguments seen repeatedly in the past can provide a useful lesson for combating them in the future.

Paula Larsson is Doctoral Student, Centre for the History of Science, Medicine, and Technology, University of Oxford.

“One-Pot,” Fluorescence-Based COVID-19 Test is Quick and Easy Source: https://www.genengnews.com/news/one-pot-fluorescence-based-covid-19-test-is-quick-and- easy/

Oct 06 – Experts have agreed, for some time now, that the United States needs better COVID-19 testing. Eight months after SARS-CoV-2 virus first entered the country, diagnostic

www.cbrne-terrorism-newsletter.com 141 HZS C2BRNE DIARY – October 2020 tests can still be hard to find, with long waits in line, and even longer wait times for results that vary in their accuracy. What is needed are diagnostic tests that are sensitive, simple, and fast. Now, a Korean team of researchers is reporting a novel assay that seems to check all of those boxes. Their method is published in Nature Biomedical Engineering in a paper titled, “Sensitive fluorescence detection of SARS-CoV-2 RNA in clinical samples via one-pot isothermal ligation and transcription.” The RT-PCR molecular test that is currently the gold standard for COVID-19 testing has very high accuracy but includes a complex preparation process to extract or refine the virus. It is not suitable for use in “pop-up” testing centers that would be useful at airports, on college campuses, drive-thru screening clinics, etc., as it requires expensive equipment as well as skilled experts. A joint research team at Pohang University of Science and Technology (POSTECH) developed a ligation-dependent isothermal reaction cascade that enables the rapid detection of RNAs with high sensitivity. The method, termed sensitive splint-based one-pot isothermal RNA detection (SENSR), allows anyone to easily and quickly diagnose COVID- 19 based on the RNA sequence of the virus. The “one-pot” assay that uses fluorescence-based detection of RNA from pathogens can be performed within 30– 50 minutes of incubation time and can reach a limit of detection of 0.1-attomolar RNA concentration.

The reaction is composed of four main components: a set of probes, SplintR ligase, T7 RNA polymerase, and a fluorogenic dye. In the presence of target RNA, hybridization, ligation, transcription, and aptamer-dye binding reactions occur sequentially in a single reaction tube at a constant temperature. [POSTECH]

“This method is a fast and simple diagnostic technology which can accurately analyze the RNA without having to treat a patient’s sample,” commented Jeong Wook Lee, PhD, assistant professor, department of chemical engineering, POSTECH. “We can better prepare for future epidemics as we can design and produce a diagnostic kit for new infectious diseases within a week.” SENSR consists of two simple enzymatic reactions: a ligation reaction by SplintR ligase and subsequent transcription by T7 RNA polymerase. The resulting transcript forms an RNA aptamer that binds to a fluorogenic dye and produces fluorescence only when target RNA exists in a sample. Isothermal amplification methods for RNA, like the one used in SENSR, have been at the center of innovative testing strategies for point-of-care detection of pathogens due to the multiple advantages. First, isothermal methods can be performed with simple, portable, and cheap equipment. Another huge advantage is that they require one single, constant temperature throughout the reaction. A simple heat block or even water bath could be used to maintain the reaction temperature needed. In addition, an isothermal reaction can reduce the overall reaction time by eliminating the time necessary for temperature adjustment, making them faster than PCR-based methods. The POSTECH researchers first demonstrated the accuracy of SENSR in two bacterial pathogens, V. vulnificus and E. coli O157:H7. They then adapted the protocol for viruses, and specifically the SARS-CoV-2 virus, designing the test kit to show fluorescence only when the viral RNA is present. In 40 nasopharyngeal SARS-CoV-2 samples, the assay reached positive and negative predictive values of 95% and 100%, respectively. The research team found the SARS-CoV- 2 virus RNA from an actual patient sample in about 30 minutes. In addition, five pathogenic

www.cbrne-terrorism-newsletter.com 142 HZS C2BRNE DIARY – October 2020 viruses and bacterial RNAs were detected which proved the kit’s usability in detecting pathogens other than COVID-19. The SENSR technology may allow the development of a diagnostic device that can be developed into a simple, portable, and easy- to-use form. If this method is introduced, it not only would allow for onsite diagnosis, but would also allow for a more proactive response to COVID-19 by supplementing the current centralized diagnostic system.

EDITOR’S COMMENT: Perhaps this new method would provide an opportunity to compate the old PCR with another method in order to see if it is as good as it claimed and considered as the “golden standard” but compared to none.

CDC Finally Admitted How Far the Coronavirus Actually Travels in Enclosed Spaces Source: https://www.sciencealert.com/the-cdc-has-just-updated-its-guidelines-coronavirus-can-travel-further-than-6-feet-in-poorly- ventilated-spaces

Oct 05 – Six feet of space is not always enough to protect you from catching someone else's coronavirus. "People who are physically near (within 6 feet [or 1.8 metres]) a person with COVID-19, or have direct contact with that person are at greatest risk of infection," the CDC said in its new guidance, posted Monday afternoon. Some of the easiest ways to get COVID-19 from someone else, the agency stressed, are: • Being around someone "with COVID-19" who might "cough, sneeze, sing, talk, or breathe." • Inhaling someone else's virus through your nose and/or mouth. • Having "close contact" with a person who is sick with the virus (as you might if you live or work with them). In an emailed statement released along with its new guidance, the agency said its recommendations for coronavirus precautions "remain the same." "CDC continues to believe, based on current science, that people are more likely to become infected the longer and closer they are to a person with COVID-19," the statement said. "People can protect themselves from the virus that causes COVID-19 by staying at least 6 feet away from others, wearing a mask that covers their nose and mouth, washing their hands frequently, cleaning touched surfaces often, and staying home when sick."

Why 6 feet isn't always sufficient: The virus thrives in stuffy spaces The agency also acknowledged, for the first time, that it's possible to catch the coronavirus from another person, even if you're further than six feet away from them - something the agency backtracked on last month. "There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away," the agency said. "These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example while singing or exercising." This acknowledgement by the CDC that the virus can be airborne - floating in smaller particles, rather than dropping to the ground - is something many other public health experts have voiced concern about in recent months. It came after the CDC, once considered the world's finest public health response team, spent weeks revising a draft form of the same guidance, that the agency said was "posted in error" and ripped from its website last month. Heavy breathing, shouting, and singing, without proper ventilation, are all thought to contribute to a "buildup" of virus-carrying particles, the CDC said, and these can more easily infect others nearby. "The take-home is that it's travelling through the air, and there is no bright line," University of Maryland virologist Don Milton (who is not affiliated with the CDC) said during a press call shortly after the CDC updated its guidance Monday. "You're not safe beyond six feet. You can't take your mask off at six feet." The World Health Organisation also acknowledged this kind of spread may be possible in July, but stressed then that it is likely limited to "crowded and inadequately ventilated spaces where infected persons spend long periods of time with others."

Surfaces, on the other hand, are 'not thought to be a common way that COVID-19 spreads,' the agency said Getting the virus from objects and surfaces is far less likely than transmission among people, the agency said, adding "it is possible that a person could get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or eyes."

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But, "touching surfaces is not thought to be a common way that COVID-19 spreads," the CDC added. Here are the most important bullet points to understand about how COVID-19 spreads best, according to the CDC:

The CDC's new guidance, published on Monday, 5 October 2020. (CDC)

Mild to Severe: Immune System Holds Clues to Virus Reaction Source: https://www.medscape.com/viewarticle/938430

Oct 01 – One of COVID-19's scariest mysteries is why some people are mildly ill or have no symptoms and others rapidly die — and scientists are starting to unravel why. An international team of researchers found that in some people with severe COVID-19, the body goes rogue and attacks one of its own key immune defenses instead of fighting the coronavirus. Most were men, helping to explain why the virus is hitting men harder than women. And separate research suggests that children fare better than adults thanks to robust "first responder" immune cells that wane with age.

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They're the latest in a list of studies uncovering multiple features of the immune system's intricate cascade that can tip the scales between a good or bad outcome. Next up: Figuring out if all these new clues might offer much-needed ways to intervene. "We have the knowledge and capability of really boosting many aspects of the immune system. But we need to not use the sledge hammer," cautioned Dr. Betsy Herold of New York's Albert Einstein College of Medicine, who co-authored the child study. Adding to the complexity, people's wildly varying reactions also reflect other factors, such as how healthy they were to begin with and how much of the virus — the "dose" — they were exposed to. "Infection and what happen after infection is a very dynamic thing," said Alessandro Sette, a researcher at the La Jolla Institute for Immunology in San Diego, who is studying yet another piece of the immune response.

Immune Primer There are two main arms of the immune system. Innate immunity is the body’s first line of defense. As soon as the body detects a foreign intruder, key molecules, such as interferons and inflammation-causing cytokines, launch a wide-ranging attack. Innate immune cells also alert the slower-acting "adaptive" arm of the immune system, the germ-specific sharpshooters, to gear up. B cells start producing virus-fighting antibodies, the proteins getting so much attention in the vaccine hunt. But antibodies aren't the whole story. Adaptive immunity's many other ingredients include "killer" T cells that destroy virus-infected cells — and "memory" T and B cells that remember an infection so they spring into action quicker if they encounter that germ again.

A Missing Piece Usually when a virus invades a cell, proteins called Type I interferons spring into action, defending the cell by interfering with viral growth. But new research shows those crucial molecules were essentially absent in a subset of people with severe COVID-19. An international project uncovered two reasons. In blood from nearly 1,000 severe COVID-19 patients, researchers found 1 in 10 had what are called auto-antibodies — antibodies that mistakenly attack those needed virus fighters. Especially surprising, autoimmune disorders tend to be more common in women — but 95% of these COVID-19 patients were men. The researchers didn't find the damaging molecules in patients with mild or asymptomatic COVID-19. In another 660 severely ill patients, the same team found 3.5% had gene mutations that didn't produce Type I interferons. Each of those silent vulnerabilities was enough to tip the balance in favor of the virus early on, said Dr. Jean-Laurent Casanova, an infectious disease geneticist at Rockefeller University in New York, who co-leads the COVID Human Genetic Effort. Certain interferons are used as medicines and are under study as a possible COVID-19 treatment; the auto-antibody discovery adds another factor to consider.

Kids' Immunity Revs Fast It's not clear why children appear less at risk from COVID-19. But occasionally they're sick enough for hospitalization, giving Herold's team the opportunity to compare 60 adults and 65 children and teens at New York’s Montefiore Health System. The children produced much higher levels of certain cytokines that are among the innate immune system's first responders. When the immune system's next stage kicked in, both adults and children made antibodies targeting the coronavirus. Here's the rub: The adults' adaptive immune response was more the type that can trigger an inflammatory overreaction. The findings suggest kids' early robust reaction lets their immune system get ahead of the virus, making an overreaction less likely "and that's protecting them," Herold said.

Any Preexisting Immunity? The coronavirus that causes COVID-19 is new to humans. But Sette's team studied blood samples that were stored in freezers before the pandemic and found some harbored memory T cells that recognized a tiny portion of the new virus in laboratory tests. "You can actually tell that this is an experienced T cell. This has seen combat before," Sette said. Researchers in Germany, Britain and other countries have made similar findings. The new coronavirus has cousins that cause as many as 30% of common colds, so researchers believe those T cells could be remnants from past colds. But despite the speculation, "we don't know yet" that having those T cells makes any difference in who gets seriously sick with COVID-19, noted Rory de Vries, co-author of a study in the Netherlands that also found such T cells in old blood. All these findings beg for a deeper understanding of the myriad ways some people can be more susceptible than others.

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"We need to look quite broadly and not jump into premature conclusions about any one particular facet of the immune system," said Stanford University immunologist Bali Pulendran. He also has found some innate immune cells "in a state of hibernation" in seriously ill adults and next is looking for differences before and after people get sick. But, "it's not just all about the immune system," cautioned Dr. Anita McElroy, a viral immunity expert at the University of Pittsburgh Medical Center who’s closely watching the research. A way to tell in advance who's most at risk? "We’re a long, long way from that."

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Enter this code: US 2020279585

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Here's How the Steroid Dexamethasone Can Make a COVID-19 Patient Feel Source: https://www.sciencealert.com/here-s-how-the-steroid-dexamethasone-can-make-a-covid-19-patient-feel

Oct 06 – President Trump started a course of the steroid dexamethasone on Saturday after a drop in blood oxygen levels, his doctor Sean Conley said. The drug treats the symptoms of COVID-19 by targeting the immune system, resulting in relief from fever and a boost in energy. The corticosteroid is typically reserved for the sickest patients, according to the World Health Organisation. Despite the presumed severity of the president's condition, he continues to project an image of good health. "I feel better than I did 20 years ago!" Trump tweeted on Monday, announcing his discharge from Walter Reed National Military Medical Centre. That may have been the steroid talking. It's possible that dexamethasone could give Trump a false sense of recovery, said Panagis Galiatsatos, MD, a pulmonary physician at Johns Hopkins Bayview Medical Centre. "Everyone who gets steroids feels a little bit better," Galiatsatos told Business Insider. "You get a steroid euphoria in addition to no fevers and so forth. So yes, there will be a moment in time where he's going to feel like, 'Oh, this is all behind me now.'" Along with acute euphoria, side effects of dexamethasone can include high blood sugar, sleep impairment, and psychosis, Galiatsatos said. COVID-19 patients typically receive 6mg of the steroid once per day for 10 days, as recommended based on the results of a clinical trial in the UK.

'It can make you feel good even though the disease is still pretty bad' Even if Trump is feeling better since receiving the steroid, he still has a more than one in five chance of dying of COVID-19 given that he required supplemental oxygen, Bob Wachter, chair of the Department of Medicine at the University of California San Francisco, told Business Insider. That probability increases given his additional risk factors, such as age and weight, and he has an even higher chance of needing intensive care if his respiratory symptoms worsen down the line. "He's on a medicine, dexamethasone, that can kind of cover up some of the symptoms," Wachter said. "It can make you feel good even though the disease is still pretty bad in you. It doesn't really change the risk that much." Dexamethasone reduced the mortality rate for COVID-19 patients who were sick enough to require supplemental oxygen, the British RECOVERY trial found. The reduction in mortality was greater for patients who required invasive mechanical ventilation than for patients who received non- invasive oxygen, such as the president. The latter group saw the mortality rate drop from 26.2 to 23.3 percent.

Steroids weaken the immune response, so it may take longer to clear the virus The benefits of taking a steroid like dexamethasone come with the cost of potentially extending the course of illness. Steroids target the immune system, not the virus itself, and a weaker immune system will take longer to fight off the virus.

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Galiatsatos said doctors prescribe steroids when the immune system is overly aggressive, such as in the case of "cytokine storms" that cause some coronavirus cases to turn deadly. Both dexamethasone and remdesivir, another medication that Trump is taking according to his doctors, are meant to curtail the hyperactive immune response, while still allowing the immune system to continue doing what it's supposed to do: fighting off the virus. "It's like putting up a fence around a bulldog. The bulldog will be there to do its stop and protect, but the fence - a.k.a. the steroid - is meant to not unleash the dog on everyone else," Galiatsatos said. If prescribed to healthy patients or those with mild symptoms, dexamethasone can destroy a well-functioning immune system, Galiatsatos said. Trump's getting prescribed the steroid would suggest that he's sicker than his doctors are letting on. The National Institutes of Health recommended against giving dexamethasone to patients who don't need assistance breathing, stipulating that the steroid is recommended only for patients who need a ventilator or extra oxygen.

Coronavirus symptoms can get better before they get worse Even without a steroid putting a leash on the immune system, doctors have observed coronavirus patients getting better, and then worse. Michelle Gong, the director of critical-care research at Montefiore Medical Centre, said in a Q&A with the Journal of the American Medical Association in March that COVID-19 patients often seem to be "doing OK, and then at around the five- to seven-day mark they start to get worse and then develop respiratory failure." According to the Centres for Disease Control and Prevention, the median time from onset of symptoms to acute respiratory distress syndrome was eight to 12 days, and the median time from onset of symptoms to ICU admission was 10 to 12 days. Trump's top doctor told reporters on Monday that the president "may not entirely be out of the woods" for another week or so, despite an altogether optimistic evaluation of POTUS' condition. "This isn't meant to cure. It's just meant to kind of keep things at bay," Galiatsatos said of the dexamethasone. "Even after the 10 days of getting the treatment, he will still be fighting the infection, and it could still do horrible things."

EDITOR’S COMMENT: Is it something fishy in the entire presidential story or is it only my feeling? Was it just a doping story before a life game or a real treatment or a treatment to show to the other competitors that America is #1 in everything? What is worse? The virus itself or the mixture of politics with health issues? Anyway, time will (soon) show what was all about. Just wait and see!

A Historical Epidemic Has Been Making a Scary Comeback Due to a Bacterial 'Clone' Source: https://www.sciencealert.com/a-bacterial-clone-is-behind-a-concerning-comeback-in-this-historical-epidemic

Oct 07 – Once a leading cause of death for children across the western world, scarlet fever was nearly eradicated thanks to 20th century medicine. But fresh outbreaks in the UK and North East Asia over recent years suggest we've still got a long way to go. Just why we're experiencing a resurgence of the deadly pathogen is a mystery. A new study has uncovered clues in the genome of one of the bacterial strains responsible, showing just how complex the family tree of infectious diseases can be. The species behind the illness is group A strep, or Streptococcus pyogenes; a ball-shaped microbe that can churn out toxic compounds called superantigens, capable of wreaking havoc inside the body. Especially in children. The results can be as mild as an uncomfortable case of pharyngitis or a bad rash, or as severe as a toxic shock that causes organs to fail. With the advent of antibiotics, outbreaks could easily be managed before they got out of hand. By the 1940s, the disease was well on the way out. That all looks to be changing. "After 2011, the global reach of the pandemic became evident with reports of a second outbreak in the UK, beginning in 2014, and we've now discovered outbreak isolates here in Australia," says University of Queensland molecular biologist Stephan Brouwer. "This global re-emergence of scarlet fever has caused a more than five-fold increase in disease rate and more than 600,000 cases around the world."

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Leading an international team of researchers in a study on group A strep genes, Brouwer has been able to characterise a variety of superantigens produced by one particular strain from North East Asia. Among them was a kind of superantigen that appears to give the bacterial invaders a clever new way to gain access to the insides of the host's cells, one never seen before among bacteria. Its novelty implies that these outbreaks aren't descended from the same strains of bacteria that have rippled through communities in centuries past. Rather, they're closely related populations of group A strep that learned a new trick or two on their own. One way similar organisms can evolve the same characteristics – such as advanced virulence – is for natural selection to independently fine-tune shared genes in the same way. But other studies have already suggested this strain of bacterium received a helping hand in the form of an infection of their own, one from a type of virus called a phage. "The toxins would have been transferred into the bacterium when it was infected by viruses that carried the toxin genes," says bioscientist Mark Walker, also from the University of Queensland. "We've shown that these acquired toxins allow Streptococcus pyogenes to better colonise its host, which likely allows it to out- compete other strains." In a process known as horizontal gene transfer, a gene that evolved in one microbe can be incorporated into a virus's genome and edited into a new host's DNA, creating a kind of clone of the original. Though hardly limited to bacteria, it is a quick and handy way for single-celled microbes to adapt. Such stolen genes can provide pathogens with new ways to gain entry to host tissues, or resist the chemical warfare that would otherwise keep them at bay. In this case, it has helped a less serious strain of bacteria to develop a weapon that makes it as concerning as its vanquished cousin. To double check the acquired superantigen's importance, the researchers used genetic editing to disable their coding. As a result, the strains lost their knack for colonising the animal models used to test the bacteria's virulence. For now, our management of an even bigger threat seems to be containing the most recent scarlet fever outbreaks. Spread through aerosols much like SARS-CoV-2, group A strep is unlikely to become an epidemic under current restrictions. "But when social distancing eventually is relaxed, scarlet fever is likely to come back," says Walker. "Just like COVID-19, ultimately a vaccine will be critical for eradicating scarlet fever – one of history's most pervasive and deadly childhood diseases."

 This research was published in Nature Communications.

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CRISPR Pioneers Doudna and Charpentier Win 2020 Nobel Prize for Chemistry Predictions over who would win the Nobel Prize for CRISPR have raged for several years. While some speculated that the award might come from the Physiology or Medicine committee, CRISPR-based therapeutics have only just entered the clinic. It will be many years before we see significant medical impact from the technology. That put the spotlight on Chemistry. There was little doubt that, should a Nobel Prize for CRISPR be awarded in Chemistry, Doudna and Charpentier would claim two of the possible three slots. + MORE

Face masks: what the data say By Lynne Peeples Nature 586, 186-189 (2020) Source: https://www.nature.com/articles/d41586-020-02801-8

Oct 06 – When her Danish colleagues first suggested distributing protective cloth face masks to people in Guinea-Bissau to stem the spread of the coronavirus, Christine Benn wasn’t so sure. “I said, ‘Yeah, that might be good, but there’s limited data on whether face masks are actually effective,’” says Benn, a global-health researcher at the University of Southern Denmark in Copenhagen, who for decades has co-led public-health campaigns in the West African country, one of the world’s poorest. Illustration by Bex Glendining That was in March. But by July, Benn and her team had worked out how to possibly provide some needed data on masks, and hopefully help people in Guinea-Bissau. They distributed thousands of locally produced cloth face coverings to people as part of a randomized controlled trial that might be the world’s largest test of masks’ effectiveness against the spread of COVID-19. Face masks are the ubiquitous symbol of a pandemic that has sickened 35 million people and killed more than 1 million. In hospitals and other health-care facilities, the use of medical-grade masks clearly cuts down transmission of the SARS-CoV-2 virus. But for the variety of masks in use by the public, the data are messy, disparate and often hastily assembled. Add to that a divisive political discourse that included a US president disparaging their use, just days before being diagnosed with COVID-19 himself. “People looking at the evidence are understanding it differently,” says Baruch Fischhoff, a psychologist at Carnegie Mellon University in Pittsburgh, Pennsylvania, who specializes in public policy. “It’s legitimately confusing.” To be clear, the science supports using masks, with recent studies suggesting that they could save lives in different ways: research shows that they cut down the chances of both transmitting and catching the coronavirus, and some studies hint that masks might reduce the severity of infection if people do contract the disease. But being more definitive about how well they work or when to use them gets complicated. There are many types of mask, worn in a variety of environments. There are questions about people’s willingness to wear them, or wear them properly. Even the question of what kinds of study would provide definitive proof that they work is hard to answer. “How good does the evidence need to be?” asks Fischhoff. “It’s a vital question.”

Beyond gold standards At the beginning of the pandemic, medical experts lacked good evidence on how SARS- CoV-2 spreads, and they didn’t know enough to make strong public-health recommendations about masks. The standard mask for use in health-care settings is the N95 respirator, which is designed to protect the wearer by filtering out 95% of airborne particles that measure 0.3 micrometres

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(µm) and larger. As the pandemic ramped up, these respirators quickly fell into short supply. That raised the now contentious question: should members of the public bother wearing basic surgical masks or cloth masks? If so, under what conditions? “Those are the things we normally [sort out] in clinical trials,” says Kate Grabowski, an infectious-disease epidemiologist at Johns Hopkins School of Medicine in Baltimore, Maryland. “But we just didn’t have time for that.” So, scientists have relied on observational and laboratory studies. There is also indirect evidence from other infectious diseases. “If you look at any one paper — it’s not a slam dunk. But, taken all together, I’m convinced that they are working,” says Grabowski. Confidence in masks grew in June with news about two hair stylists in Missouri who tested positive for COVID-191. Both wore a double-layered cotton face covering or surgical mask while working. And although they passed on the infection to members of their households, their clients seem to have been spared (more than half reportedly declined free tests). Other hints of effectiveness emerged from mass gatherings. At Black Lives Matter protests in US cities, most attendees wore masks. The events did not seem to trigger spikes in infections2, yet the virus ran rampant in late June at a Georgia summer camp, where children who attended were not required to wear face coverings3. Caveats abound: the protests were outdoors, which poses a lower risk of COVID-19 spread, whereas the campers shared cabins at night, for example. And because many non-protesters stayed in their homes during the gatherings, that might have reduced virus transmission in the community. Nevertheless, the anecdotal evidence “builds up the picture”, says Theo Vos, a health-policy researcher at the University of Washington in Seattle. More-rigorous analyses added direct evidence. A preprint study4 posted in early August (and not yet peer reviewed), found that weekly increases in per-capita mortality were four times lower in places where masks were the norm or recommended by the government, compared with other regions. Researchers looked at 200 countries, including Mongolia, which adopted mask use in January and, as of May, had recorded no deaths related to COVID-19. Another study5 looked at the effects of US state-government mandates for mask use in April and May. Researchers estimated that those reduced the growth of COVID-19 cases by up to 2 percentage points per day. They cautiously suggest that mandates might have averted as many as 450,000 cases, after controlling for other mitigation measures, such as physical distancing. “You don’t have to do much math to say this is obviously a good idea,” says Jeremy Howard, a research scientist at the University of San Francisco in California, who is part of a team that reviewed the evidence for wearing face masks in a preprint article that has been widely circulated6. But such studies do rely on assumptions that mask mandates are being enforced and that people are wearing them correctly. Furthermore, mask use often coincides with other changes, such as limits on gatherings. As restrictions lift, further observational studies might begin to separate the impact of masks from those of other interventions, suggests Grabowski. “It will become easier to see what is doing what,” she says. Although scientists can’t control many confounding variables in human populations, they can in animal studies. Researchers led by microbiologist Kwok-Yung Yuen at the University of Hong Kong housed infected and healthy hamsters in adjoining cages, with surgical-mask partitions separating some of the animals. Without a barrier, about two-thirds of the uninfected animals caught SARS- CoV-2, according to the paper7 published in May. But only about 25% of the animals protected by mask material got infected, and those that did were less sick than their mask-free neighbours (as measured by clinical scores and tissue changes). The findings provide justification for the emerging consensus that mask use protects the wearer as well as other people. The work also points to another potentially game-changing idea: “Masking may not only protect you from infection but also from severe illness,” says Monica Gandhi, an infectious-disease physician at the University of California, San Francisco. Gandhi co-authored a paper8 published in late July suggesting that masking reduces the dose of virus a wearer might receive, resulting in infections that are milder or even asymptomatic. A larger viral dose results in a more aggressive inflammatory response, she suggests. She and her colleagues are currently analysing hospitalization rates for COVID-19 before and after mask mandates in 1,000 US counties, to determine whether the severity of disease decreased after public masking guidelines were brought in. The idea that exposure to more virus results in a worse infection makes “absolute sense”, says Paul Digard, a virologist at the University of Edinburgh, UK, who was not involved in the research. “It’s another argument for masks.” Gandhi suggests another possible benefit: if more people get mild cases, that might help to enhance immunity at the population level without increasing the burden of severe illness and death. “As we’re awaiting a vaccine, could driving up rates of asymptomatic infection do good for population-level immunity?” she asks.

Back to ballistics The masks debate is closely linked to another divisive question: how does the virus travel through the air and spread infection?

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The moment a person breathes or talks, sneezes or coughs, a fine spray of liquid particles takes flight. Some are large — visible, even — and referred to as droplets; others are microscopic, and categorized as aerosols. Viruses including SARS-CoV-2 hitch rides on these particles; their size dictates their behaviour. Droplets can shoot through the air and land on a nearby person’s eyes, nose or mouth to cause infection. But gravity quickly pulls them down. Aerosols, by contrast, can float in the air for minutes to hours, spreading through an unventilated room like cigarette smoke.

Time-lapse images show how cough droplets spread from a person wearing an N95 mask that has a valve to expel exhaled air. Credit: S. Verma et al./Phys. Fluids [CLICK on source’s URL to see the time-lapse in motion]

What does this imply for the ability of masks to impede COVID-19 transmission? The virus itself is only about 0.1 µm in diameter. But because viruses don’t leave the body on their own, a mask doesn’t need to block particles that small to be effective. More relevant are the pathogen-transporting droplets and aerosols, which range from about 0.2 µm to hundreds of micrometres across. (An average human hair has a diameter of about 80 µm.) The majority are 1–10 µm in diameter and can linger in the air a long time, says Jose- Luis Jimenez, an environmental chemist at the University of Colorado Boulder. “That is where the action is.” Scientists are still unsure which size of particle is most important in COVID-19 transmission. Some can’t even agree on the cut-off that should define aerosols. For the same reasons, scientists still don’t know the major form of transmission for influenza, which has been studied for much longer. Many believe that asymptomatic transmission is driving much of the COVID-19 pandemic, which would suggest that viruses aren’t typically riding out on coughs or sneezes. By this reasoning, aerosols could prove to be the most important transmission vehicle. So, it is worth looking at which masks can stop aerosols.

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All in the fabric Even well-fitting N95 respirators fall slightly short of their 95% rating in real-world use, actually filtering out around 90% of incoming aerosols down to 0.3 µm. And, according to unpublished research, N95 masks that don’t have exhalation valves — which expel unfiltered exhaled air — block a similar proportion of outgoing aerosols. Much less is known about surgical and cloth masks, says Kevin Fennelly, a pulmonologist at the US National Heart, Lung, and Blood Institute in Bethesda, Maryland. In a review9 of observational studies, an international research team estimates that surgical and comparable cloth masks are 67% effective in protecting the wearer. In unpublished work, Linsey Marr, an environmental engineer at Virginia Tech in Blacksburg, and her colleagues found that even a cotton T-shirt can block half of inhaled aerosols and almost 80% of exhaled aerosols measuring 2 µm across. Once you get to aerosols of 4–5 µm, almost any fabric can block more than 80% in both directions, she says. Multiple layers of fabric, she adds, are more effective, and the tighter the weave, the better. Another study10 found that masks with layers of different materials — such as cotton and silk — could catch aerosols more efficiently than those made from a single material. Benn worked with Danish engineers at her university to test their two-layered cloth mask design using the same criteria as for medical-grade ventilators. They found that their mask blocked only 11–19% of aerosols down to the 0.3 µm mark, according to Benn. But because most transmission is probably occurring through particles of at least 1 µm, according to Marr and Jimenez, the actual difference in effectiveness between N95 and other masks might not be huge. Eric Westman, a clinical researcher at Duke University School of Medicine in Durham, North Carolina, co-authored an August study11 that demonstrated a method for testing mask effectiveness. His team used lasers and smartphone cameras to compare how well 14 different cloth and surgical face coverings stopped droplets while a person spoke. “I was reassured that a lot of the masks we use did work,” he says, referring to the performance of cloth and surgical masks. But thin polyester-and-spandex neck gaiters — stretchable scarves that can be pulled up over the mouth and nose — seemed to actually reduce the size of droplets being released. “That could be worse than wearing nothing at all,” Westman says. Some scientists advise not making too much of the finding, which was based on just one person talking. Marr and her team were among the scientists who responded with experiments of their own, finding that neck gaiters blocked most large droplets. Marr says she is writing up her results for publication. “There’s a lot of information out there, but it’s confusing to put all the lines of evidence together,” says Angela Rasmussen, a virologist at Columbia University’s Mailman School of Public Health in New York City. “When it comes down to it, we still don’t know a lot.”

Minding human minds Questions about masks go beyond biology, epidemiology and physics. Human behaviour is core to how well masks work in the real world. “I don’t want someone who is infected in a crowded area being confident while wearing one of these cloth coverings,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis.

US baseball players wore masks while playing during the 1918 influenza epidemic. Credit: Underwood And Underwood/LIFE Images Collection/Getty

Perhaps fortunately, some evidence12 suggests that donning a face mask might drive the wearer and those around them to adhere better to other measures, such as social distancing. The masks remind them of shared responsibility, perhaps. But that requires that people wear them. Across the United States, mask use has held steady around 50% since late July. This is a substantial increase from the 20% usage seen in March and April, according to data from the Institute for Health Metrics and Evaluation at the University of Washington in Seattle (see go.nature.com/30n6kxv). The institute’s models also predicted that, as of 23 September, increasing US mask use to 95% — a level observed in Singapore and some other countries — could save nearly 100,000 lives in the period up to 1 January 2021.

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“There’s a lot more we would like to know,” says Vos, who contributed to the analysis. “But given that it is such a simple, low-cost intervention with potentially such a large impact, who would not want to use it?” Further confusing the public are controversial studies and mixed messages. One study13 in April found masks to be ineffective, but was retracted in July. Another, published in June14, supported the use of masks before dozens of scientists wrote a letter attacking its methods (see go.nature.com/3jpvxpt). The authors are pushing back against calls for a retraction. Meanwhile, the World Health Organization (WHO) and the US Centers for Disease Control and Prevention (CDC) initially refrained from recommending widespread mask usage, in part because of some hesitancy about depleting supplies for health-care workers. In April, the CDC recommended that masks be worn when physical distancing isn’t an option; the WHO followed suit in June. There’s been a lack of consistency among political leaders, too. US President Donald Trump voiced support for masks, but rarely wore one. He even ridiculed political rival Joe Biden for consistently using a mask — just days before Trump himself tested positive for the coronavirus, on 2 October. Other world leaders, including the president and prime minister of Slovakia, Zuzana Čaputová and Igor Matovič, sported masks early in the pandemic, reportedly to set an example for their country. Denmark was one of the last nations to mandate face masks — requiring their use on public transport from 22 August. It has maintained generally good control of the virus through early stay-at-home orders, testing and contact tracing. It is also at the forefront of COVID-19 face-mask research, in the form of two large, randomly controlled trials. A research group in Denmark enrolled some 6,000 participants, asking half to use surgical face masks when going to a workplace. Although the study is completed, Thomas Benfield, a clinical researcher at the University of Copenhagen and one of the principal investigators on the trial, says that his team is not ready to share any results. Benn’s team, working independently of Benfield’s group, is in the process of enrolling around 40,000 people in Guinea-Bissau, randomly selecting half of the households to receive bilayer cloth masks — two for each family member aged ten or over. The team will then follow everyone over several months to compare rates of mask use with rates of COVID-like illness. She notes that each household will receive advice on how to protect themselves from COVID-19 — except that those in the control group will not get information on the use of masks. The team expects to complete enrolment in November. Several scientists say that they are excited to see the results. But others worry that such experiments are wasteful and potentially exploit a vulnerable population. “If this was a gentler pathogen, it would be great,” says Eric Topol, director of the Scripps Research Translational Institute in La Jolla, California. “You can’t do randomized trials for everything — and you shouldn’t.” As clinical researchers are sometimes fond of saying, parachutes have never been tested in a randomized controlled trial, either. But Benn defends her work, explaining that people in the control group will still benefit from information about COVID-19, and they will get masks at the end of the study. Given the challenge of manufacturing and distributing the masks, “under no circumstances”, she says, could her team have handed out enough for everyone at the study’s outset. In fact, they had to scale back their original plans to enrol 70,000 people. She is hopeful that the trial will provide some benefits for everyone involved. “But no one in the community should be worse off than if we hadn’t done this trial,” she says. The resulting data, she adds, should inform the global scientific debate. For now, Osterholm, in Minnesota, wears a mask. Yet he laments the “lack of scientific rigour” that has so far been brought to the topic. “We criticize people all the time in the science world for making statements without any data,” he says. “We’re doing a lot of the same thing here.” Nevertheless, most scientists are confident that they can say something prescriptive about wearing masks. It’s not the only solution, says Gandhi, “but I think it is a profoundly important pillar of pandemic control”. As Digard puts it: “Masks work, but they are not infallible. And, therefore, keep your distance.”

Lynne Peeples is a science journalist in Seattle, Washington.

Emergency Authorisation Was Just Requested for a New COVID-19 Treatment Source: https://www.sciencealert.com/us-pharmaceutical-firm-applies-for-emergency-authorisation-of-covid-antibody-therapy

Oct 08 – The US pharmaceutical firm Eli Lilly on Wednesday announced it had applied for an emergency use authorization (EUA) for a lab-produced antibody treatment against COVID-19, after early trial results showed it reduced viral load, symptoms and hospitalization rates. "Our teams have worked tirelessly the last seven months to discover and develop these potential antibody treatments," said Daniel Skovronsky, Lilly's chief scientific officer.

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The company is studying two treatments: one is a "monotherapy" of one antibody, and the other is a "combination therapy" of two antibodies working together. In a briefing document, Lilly said it had applied for an EUA for the monotherapy and would likely apply for the combination therapy by November, once more safety data is in. Its combination therapy of two antibodies working together was shown to be effective in a placebo-controlled Phase 2 (middle-stage) study of 268 patients with mild to moderate COVID-19. The company's analysis showed the proportion of patients with high viral load at day 7 of their illness was 3.0 percent on the therapy, compared to 20.8 percent on the placebo arm. Improvement in symptoms was seen as early as three days after dosing. The rate of COVID-related hospitalization and emergency visits was 0.9 percent for patients treated with combination therapy versus 5.8 percent on placebo, a relative risk reduction of 84.5 percent. The results for the monotherapy were also positive though less marked – the rate of hospitalization and emergency visits was 1.6 percent across all dose levels. One of the patients on the combination treatment had a serious side effect – a urinary tract infection – but the company said they thought this was unrelated to the study. The trial is ongoing and Lilly wants to recruit a total of 800 people. The therapies are also being studied for their potential use as a prophylaxis and as a treatment for hospitalized patients in separate trials. Lilly said it expects to have 100,000 doses of the monotherapy available this month, and a million by the end of the year. It also expects to have 50,000 doses of the combination therapy by the end of 2020. The findings have not yet been published in a peer-reviewed journal. Both antibodies work by binding to different parts of spike proteins on the surface of the SARS-CoV-2 virus, distorting their structure so the virus can't invade living cells. Antibodies are infection-fighting proteins made by the immune system and can also be harvested from recovered patients, but it is not thought possible to make so-called "convalescent plasma" a mass treatment. Researchers can also comb through the antibodies produced by recovered patients and select the most effective out of thousands, and then manufacture them at scale. US President Donald Trump, who has COVID-19, received a dose of synthetic antibodies produced by the firm Regeneron last week. Regeneron has also reported encouraging results from its early trials, but hasn't yet applied for emergency approval and so remains an experimental treatment. The US Food and Drug Administration has previously granted an EUA for the antiviral remdesivir, for convalescent plasma, and for hydroxychloroquine, which was subsequently revoked over safety fears. In addition, US health authorities recommend the use of the steroid dexamethasone to control a damaging inflammatory response seen in later stages of COVID-19.

DoD Test of Viral Spread on Commercial Planes Reveals Good News, General Says Source: https://www.military.com/daily-news/2020/10/07/dod-test-of-viral-spread-commercial-planes-reveals-good-news-general- says.html

Oct 07 – The head of U.S. Transportation Command offered a sneak preview Wednesday of the results of a Defense Department test of particulate spread on commercial aircraft -- and they are surprising. Speaking at the National Defense Transportation Association's annual fall meeting, Gen. Stephen Lyons cited an aerosol test held Aug. 24-31 aboard two large passenger aircraft: the Boeing 767-300 and 777-200. The Defense Advanced Research Projects Agency, better known as DARPA, teamed up with biodefense company Zeteo Tech Inc. to evaluate in-flight spread of airborne particles. Industry partners included Boeing and United Airlines. "[The test] was an initiative initiated by TRANSCOM and supported by the Air Force and the test community to determine whether it's safe to fly on commercial airliners," Lyons said Wednesday. "And I have to tell you, their results, as were the results when we looked at this from the COVID patient movement challenge, are very, very encouraging."

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There are some qualifiers, Lyons noted. The conditions that yielded positive results, he said, involved aircraft with HEPA filtration and "a very, very high air exchange rate of every two to five minutes or two to three minutes." But under those conditions, he indicated, particle spread rates were even lower than in a conventional indoor setting. "In fact, I would tell you that in my observations, and I've flown commercially since the pandemic started, being on a commercial airplane with HEPA filtration is probably one of the safest places that you can be," Lyons said. "And those test reports will be out very, very soon."

David Silcott, left, chief executive of S3i, goes over an airflow particle test for Navy Vice Adm. Dee Mewbourne, right, deputy commander, U.S. Transportation Command, on board a United Airlines 767 aircraft at Dulles International Airport, Va., Aug. 28, 2020. (DoD/ Stephenie Wade)

According to a September Defense Department test, TRANSCOM undertook this research in order to determine the safety of DoD- contracted Patriot Express, or commercial charter flights, used to transport military family members and others on official duty. The tests were conducted on a 767 and 777, officials said, because those are the aircraft most typically used for these flights. According to the release, fluorescent tracer particles meant to simulate viral particles were released at rates of 2 to 4 minutes, both in the air and on the ground. Mannequins representing passengers were positioned throughout the aircraft, some wearing masks and some without. The evaluators also tested a variety of scenarios, releasing particles in the cockpit as well as in the cabin, at the terminal with the cabin door open and at the terminal with doors closed but with air recirculation via an auxiliary power unit. "The test will help U.S. TRANSCOM understand the aerosol particle field generated by a passenger shedding viral material and the exposure risk to crew and passengers," Navy Lt. Cmdr. Joseph Pope, TRANSCOM operations directorate liaison for the airflow particle test, said in a statement. Lyons did not offer details in his address about any differences in test outcome for masked and nonmasked passengers, whether position in the aircraft made a difference or what specific scenario outcomes showed.

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According to the release, test results were due to TRANSCOM in September and then set to be reported to the Defense Department's COVID-19 task force. The Defense Department, which shut down most "Space-A" passenger travel at the start of the pandemic in March, cautiously restarted flights in May with extensive restrictions, including mask-wearing and 14-day quarantine upon arrival. Once released, the full results of the test could change procedures for passenger transport. "This data collected will eventually inform the Department of Defense on contact tracing requirements needed for specific aircraft," Pope said in the September release. "It will also be used to develop strategies like cabin loading and seating configurations to mitigate potential risk of inter-person transmission of the aerosol particles." In addition, he said, the tests could help determine who needs to self-quarantine if it's discovered a passenger on their aircraft tested positive for COVID-19. "It could be the difference between the whole aircraft isolating compared to one person," Pope said.

 Read the final report: https://www.ustranscom.mil/cmd/docs/TRANSCOM%20Report%20Final.pdf

SARS-CoV-2 Antibodies Persist for Months after Infection Source: https://www.genengnews.com/news/sars-cov-2-antibodies-persist-for-months-after-infection/

Oct 09 – COVID-19 researchers have been trying to understand the immune response that follows a SARS-CoV-2 infection since the virus first started circulating in the United States. Knowledge surrounding both the T cell and B cell responses to the infection, and the amount of time that each one remains active, is an important factor to implement strategies to combat the pandemic. Now, new findings suggest that antibodies against SARS-CoV-2 can last at least three months after a person becomes infected with the virus. Two separate studies, published together in Science Immunology, have documented the persistence of antibodies that target SARS-CoV-2 in hundreds of patients with COVID-19 at least three months after symptom onset. Both studies point to the IgG class of antibodies as the longest-lasting antibodies detectable in the blood and saliva of patients during this timeframe, suggesting that SARS-CoV-2-specific IgG antibodies may serve as promising targets to detect and evaluate immune responses against the virus. One group’s work is published in a paper titled, “Persistence of serum and saliva antibody responses to SARS-CoV-2 spike antigens in COVID-19 patients.” Researchers used saliva and blood samples from COVID-19 patients to measure and compare antibody levels for over three months post-symptom onset. They found that IgG antibodies that bind to the SARS-CoV-2 spike protein are detectable for at least 115 days, representing the longest time interval measured. The study is also the first to show these antibodies can also be detected in the saliva. The researchers found that while IgA and IgM antibodies targeting the spike protein’s receptor binding domain rapidly decayed, IgG antibodies remained relatively stable for up to 105 days after symptom onset in 402 patients with COVID-19. They charted the patients’ antibody responses from 3 to 115 days after symptom onset, and compared their profiles with 339 pre-pandemic controls. Patients with COVID-19 showed peak IgG levels at 16 to 30 days after the appearance of symptoms. Levels of all spike protein-specific IgG, IgM, and IgA antibodies in the blood positively correlated with levels observed in matched saliva samples. “Our study shows that IgG antibodies against the spike protein of the virus are relatively durable in both blood and saliva,” said Jennifer Gommerman, PhD, professor of immunology at the University of Toronto. “Our study suggests saliva may serve as an alternative for antibody testing. While saliva is not as sensitive as serum, it is easy to collect.” While the team admits there is a lot, they still don’t know about antibody responses to SARS-CoV-2 infection, including how long the antibodies last beyond this period or what protection they afford against re-infection, this research could have broader implications in the development of an effective vaccine. “This study suggests that if a vaccine is properly designed, it has the potential to induce a durable antibody response that can help protect the vaccinated person against the virus that causes COVID-19,” Gommerman said. The second study, led by a Boston group, is published in the paper titled, “Persistence and decay of human antibody responses to the receptor binding domain of SARS-CoV-2 spike protein in COVID-19 patients.”

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The team measured antibody responses in the blood of 343 patients with COVID-19 for up to 122 days after symptom onset—and compared these responses to those of 1,548 control individuals sampled before the pandemic. The researchers focused only on antibodies specific to the SARS-CoV-2 spike protein’s receptor binding domain. To provide a baseline, the researchers estimated sensitivities of IgG, IgA, and IgM antibody types at 95%, 90%, and 81%, respectively, for detecting infected individuals between 15 to 28 weeks after symptom onset. Among these antibodies, spike protein-specific IgM and IgA were short-lived, dropping beneath detection levels at around 49 and 71 days, respectively, after the appearance of symptoms. In contrast, spike protein-targeted IgG responses decayed slowly over a period of 90 days, with only three individuals losing them within this timeframe. Levels of spike protein-specific IgG strongly correlated with levels of neutralizing antibodies in the patients. The researchers also did not observe cross-reactivity of any SARS-CoV-2-targeting antibodies with other “common cold” coronaviruses. IgG levels remained elevated in these patients for four months, and were associated with the presence of protective neutralizing antibodies, which also demonstrated little decrease in activity over time. “That means that people are very likely protected for that period of time,” said Richelle Charles, MD, an investigator in the division of infectious diseases at MGH. “We showed that key antibody responses to COVID-19 do persist.” In another finding, Charles and her colleagues showed that people infected with SARS-CoV-2 had IgA and IgM responses that were relatively short-lived, declining to low levels within about two and a half months or less, on average. “We can say now that if a patient has IgA and IgM responses, they were likely infected with the virus within the last two months,” said Charles. Knowing the duration of the immune response by IgA and IgM will help scientists obtain more accurate data about the spread of SARS-CoV-2, explained Jason Harris, MD, a pediatric infectious disease specialist at MGH and co-senior author of the study. “There are a lot of infections in the community that we do not pick up through PCR testing during acute infection, and this is especially true in areas where access to testing is limited,” he said. “Knowing how long antibody responses last is essential before we can use antibody testing to track the spread of COVID-19 and identify ‘hot spots’ of the disease.”

Direct detection of SARS-CoV-2 using CRISPR-Cas13a and a mobile phone By Parinaz Fozouni, Sungmin Son, María Díaz de León Derby, et al. Source: https://www.medrxiv.org/content/10.1101/2020.09.28.20201947v1.full.pdf

Sep 30 – The December 2019 outbreak of a novel respiratory virus, SARS-CoV-2, has become an ongoing global pandemic due in part to the challenge of identifying symptomatic, asymptomatic and pre- symptomatic carriers of the virus. CRISPR-based diagnostics that utilize RNA and DNA-targeting enzymes can augment gold-standard PCR-based testing if they can be made rapid, portable and accurate. Here we report the development of an amplification-free CRISPR-Cas13a-based mobile phone assay for direct detection of SARS-CoV-2 from nasal swab RNA extracts. The assay achieved ~100 copies/μL sensitivity in under 30 minutes and accurately detected a set of positive clinical samples in under 5 minutes. We combined crRNAs targeting SARS-CoV-2 RNA to improve sensitivity and specificity, and we directly quantified viral load using enzyme kinetics. Combined with mobile phone-based quantification, this assay can provide rapid, low-cost, point-of-care screening to aid in the control of SARS-CoV-2.

EDITOR’S COMMENT: A second alternative to “old” PCR – now we have two technigues [the other is the “sensitive splint- based one-pot isothermal RNA detection (SENSR)”], to discover how “gold” is the gold standard!

Judaism, COVID and public health By Dr. Mark Fenig Source: http//www.nydailynews.com

Oct 09 – “To save a single life is to save the entire world.” Growing up in an Orthodox Jewish community, I heard this Talmudic expression countless times. It may have even influenced

www.cbrne-terrorism-newsletter.com 157 HZS C2BRNE DIARY – October 2020 my decision to go to public health school and medical school, and to eventually become an emergency medicine physician. Ironically, the same culture that prioritizes human life has played host to disturbing scenes of mask-burning and shameful violence in response to new gathering restrictions imposed to curb the recent spike in COVID-19 cases. As a physician, I am deeply troubled by the risk that communities of anti-maskers present to themselves and their neighbors. As a Jew, I am appalled by the lack of responsible leadership in the ultra- Orthodox ZIP codes that has led these residents to this dangerous place. And as a New Yorker, I’m dismayed by the city’s failure to prevent this crisis. The fact that these communities were gripped by a disproportionate amount of suffering and death during April’s coronavirus surge serves only to compound the apparent cognitive dissonance. Many are unfortunately using this moment as a broad-brush referendum on the ultra- Orthodox New Yorkers' culture. Instead, this moment must be used as a referendum on our ability to deliver effective public health to a city made up of radically diverse communities. Yom Kippur, a day when Jews fast and meditate on personal shortcomings and missed opportunities, was observed last week. My mind gravitated toward times during long, tiring shifts that I didn’t review a medication list with a patient, or more thoroughly explain their disease process. Shifts are long and exhausting and some opportunities are missed. We must also think about our city’s public health failures. What’s happening in these nine ZIP codes should have been no surprise. Three ingredients for the spike in cases we are now seeing have existed for months: a deficit of scientific literacy, a mistaken belief that April’s horrendous morbidity and mortality resulted in herd immunity and a longstanding distrust of outside, secular leadership borne of generations of collective trauma. The imposition of new restrictions in these communities therefore feels punitive, even though it is not. Knowledge of the widespread infections these communities are experiencing — a 6% positivity rate of COVID infection while the rest of the state is closer to 1% — has not reached many of its members who customarily abstain from all things secular, including the internet and television. The past five months were New York City’s missed opportunity. An opportunity surely recognized by the political leaders of these neighborhoods who, along with anyone passing through, must have noticed that mask-wearing was eschewed. Did the city thoroughly assess beliefs in these communities? Effectively educate community members about the spread of the virus in the right languages? Develop real-time, dynamic methods of updating community members about current COVID statistics without relying on television or the internet? Form appropriate partnerships and task forces with community leaders? Whatever they tried; they didn’t try hard enough. Community leaders and clergy have an immediate obligation to disabuse their constituents and congregants of their mistaken belief in herd immunity, and urge them to comply with the protective restrictions. Physicians like myself must also do a better job of educating each other and our patients. One friend had to recently change Brooklyn pediatricians after learning she, too, espoused the herd immunity theory. It’s not just these nine ZIP codes. People from all over New York have been exposed to pseudoscience: “the current low death toll means we have herd immunity,” or “better treatment means getting sick is no longer a big deal,” or “children can’t get COVID or infect others.” In this crisis, these kinds of misunderstandings can be lethal. Here is what we now know: Herd immunity has apparently not yet been achieved, even in the hardest-hit areas. Yes, we have gotten better at treating COVID patients, but not everyone survives. More importantly, if hospitals become overcrowded, we won’t be able to deliver the best care possible. Children of all ages do get infected and spread COVID. However, if they are less than 10 years old, they do this less effectively. Finally, and this is critical: Other people’s masks are still your best defense. No matter your perspective on these hard-hit religious communities, it is science, not faith, that is now teaching us that we are all connected in a very real, epidemiologic way. And we

www.cbrne-terrorism-newsletter.com 158 HZS C2BRNE DIARY – October 2020 share one thing in common: our desire to protect ourselves and loved ones from getting infected. To do this, we must have a more enlightened and effective public health approach. The city’s attention is now directed at these hot zones. This opportunity must not be squandered.

Prof Mark Fenig, MD has practiced emergency medicine in New York City for over a decade and is an assistant professor of emergency medicine at Albert Einstein College of Medicine.

Do cloth masks work? Only if you machine wash them after use Βy Australian Research Council Source: https://medicalxpress.com/news/2020-10-masks-machine.html

Oct 09 – A new publication from researchers at UNSW Sydney advises daily washing of cloth masks to reduce the likelihood of contamination and transmission of viruses like SARS-CoV-2. Cloth masks must be washed daily at high temperatures to be protective against infection, a new analysis from the Kirby Institute at UNSW Sydney published in BMJ Open suggests. "Both cloth masks and surgical masks should be considered 'contaminated' after use," says Professor Raina MacIntyre, who conducted the study. "Unlike surgical masks, which are disposed of after use, cloth masks are re-used. While it can be tempting to use the same mask for multiple days in a row, or to give it a quick hand-wash or wipe-over, our research suggests that this increases the risk of contamination." The researchers analyzed unpublished data from a randomized controlled trial (RCT) they published in 2015. This study is still the only RCT ever conducted on the efficacy of cloth masks in preventing viral infections. "Given the potential implications for health workers or community members who are using cloth masks during the pandemic, we did a deep dive into the 2011 data on whether the health workers in our study washed their masks daily, and if so, how they washed their masks. We found that if cloth masks were washed in the hospital laundry, they were as effective as a surgical mask." It is important to note that given the study was conducted over five years ago, the researchers did not test for SARS-CoV-2—instead, they included common respiratory pathogens such as influenza, rhinoviruses and seasonal coronaviruses in their analysis. It is based on self-reported washing data and was conducted by health workers in high risk wards in a healthcare setting. "While someone from the general public wearing a cloth mask is unlikely to come into contact with the same amount of pathogens as healthcare worker in a high risk ward, we would still recommended daily washing of cloth masks in the community. COVID-19 is a highly infectious virus, and there is still a lot that we don't know about it, and so it's important that we take every precaution we can to protect against it and ensure masks are effective," says Professor MacIntyre. According to the analysis, handwashing the masks did not provide adequate protection. Healthcare workers who self-washed their masks by hand had double the risk of infection compared to those who used the hospital laundry. The majority of people in the RCT handwashed their masks, and this may be why the cloth masks performed poorly in the original trial. "The WHO recommends machine washing masks with hot water at 60 degrees Celsius and laundry detergent, and the results of our analysis support this recommendation," says Professor MacIntyre. "Washing machines often have a default temperature of 40 degree or 60 degrees, so do check the setting. At these very hot temperatures, handwashing is not possible. The clear message from this research is that cloth masks do work—but once a cloth mask has been worn, it needs to be washed properly each time before being worn again, otherwise it stops being effective." The original study was conducted in hospital health workers in Vietnam in 2011. Study participants were randomly assigned to use cloth masks, surgical masks or no masks. The researchers found that 2-layered cotton cloth masks were not as effective as surgical masks

www.cbrne-terrorism-newsletter.com 159 HZS C2BRNE DIARY – October 2020 in a hospital setting, and that they potentially increased the risk of infection, when compared with wearing no mask at all. "This has become a flashpoint for the debate around cloth masks between pro and anti-mask groups, both of which have focused on our 2015 study in their arguments—but a more detailed look at the washing data suggests that hand-washing made the cloth masks riskier, rather than the cloth mask itself. When we break the data down in this new way, comparing machine washing with handwashing, a machine-washed cloth mask is as effective as a surgical mask," says Professor MacIntyre. "There is much research on the design, fabric and construction of masks, but washing is also key for protection."

Relation of Statin Use Prior to Admission to Severity and Recovery Among COVID- 19 Inpatients By Lori B. Daniels, MD, MAS, Amy M. Sitapati, MD, Jing Zhang, MS, et al. American Journal of Cardiology | September 15, 2020 Source: https://www.ajconline.org/article/S0002-9149(20)30947-4/fulltext

In conclusion, statin use during the 30 days prior to admission for COVID-19 was associated with a lower risk of developing severe COVID-19, and a faster time to recovery among patients without severe disease.

Cholesterol 25‐Hydroxylase inhibits SARS‐CoV‐2 and other coronaviruses by depleting membrane cholesterol By Shaobo Wang, Wanyu Li, Hui Hui, et al. The EMBO Journal | October 05, 2020 Source: https://www.embopress.org/doi/full/10.15252/embj.2020106057

Altogether, our results shed light on a potentially broad antiviral mechanism by 25HC through depleting accessible cholesterol on the plasma membrane to suppress virus–cell fusion. Since 25HC is a natural product with no known toxicity at effective concentrations, it provides a potential therapeutic candidate for COVID‐19 and emerging viral diseases in the future.

5 Things to Know About a COVID Vaccine: It Won’t Be a ‘Magic Wand’ By Julie Appleby Source: https://khn.org/news/5-things-to-know-about-a-covid-vaccine-it-wont-be-a-magic-wand/

Oct 05 – President Donald Trump makes no secret he would like a COVID-19 vaccine to be available before the election. But it’s doubtful that will happen and, even after a vaccine wins FDA approval, there would be a long wait before it’s time to declare victory over the virus. Dozens of vaccine candidates are in various testing stages around the world, with 11 in the last stage of preapproval clinical trials — including four in the U.S. One or more may prove safe and effective and enter the market in the coming months. What then? Here are five things to consider in making vaccine dreams come true.

1. A vaccine is vital in fighting the virus, but it won’t be a quick pass back to our old lives. Vaccines have helped rid the world of scourges like smallpox, but the process takes time and there are no guarantees. Until clinical trials have been completed on this first round of vaccine candidates, no one knows how effective they might prove to be. The minimum requirement by the Food and Drug Administration for any COVID-19 vaccine is that it should at least prove 50% effective when compared with a placebo — that is, a neutral saline solution. By comparison, the annual influenza vaccine ranges between 40% and 60% effective in preventing the illness, depending on the recipient and the season examined. In contrast, a full course of the measles vaccine is about 97% effective.

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“It’s very unlikely that a first-generation vaccine will be something like a measles vaccine,” notes Dr. Amesh Adalja, a physician with expertise in infectious diseases and senior scholar at the Johns Hopkins University Center for Health Security. 2. After vaccines gain approval, the real-world evaluation ensues. Vaccines undergo a protracted testing process involving thousands of subjects. They win FDA approval only after they demonstrate safety and meet at least the minimum standard of effectiveness. Monitoring continues after they hit the market; effectiveness and any rare side effects or safety issues become more apparent after millions of doses are given. Hypothetically, let’s say the first new COVID vaccines prove 70% effective at preventing the disease. That would mean seven of every 10 people who roll up their sleeves will be protected, but three will not. While that’s good news for those protected, questions remain about who is covered and who is still vulnerable. It’s possible, Adalja said, that the vaccine would reduce the severity of disease in the remaining three people, thereby helping cut hospitalizations and severe side effects. But it’s also true that regulators are focused on whether a vaccine prevents disease. Some vaccines can keep you from getting sick without preventing infection, in which case you could still spread the virus even without exhibiting symptoms. Mysteries remain, at least for now. Scientists don’t know how long the protection will last, for instance. Will protection fade, requiring annual shots, as with influenza? Or will it last for years? Also, the COVID vaccine candidates are being tested only in adults so far. Most vaccine makers have delayed testing among children or pregnant and breastfeeding women, for example. That could mean an initial lag in safety and efficacy data for those groups, complicating vaccination efforts for children or even front-line health care workers, many of whom are women of childbearing age. For all those reasons — “if you are looking for a magic wand, you won’t find one in vaccines,” said Dr. William Schaffner, a professor of preventive medicine and infectious disease at Vanderbilt University Medical Center in Nashville, Tennessee. “That said, vaccines will play a substantial role in reducing the epidemic.”

3. After a vaccine is approved, you still may need to wait awhile to get your shot. Making vaccines is complicated. And so is distributing them. Vaccine makers say they are already producing vaccine in advance of knowing whether they will win approval. But simply having ample vaccine supply doesn’t mean manufacturers will have all the needed glass bottles, syringes or injectors to ship them right away. Indeed, some experts fear that a shortage of both production-line capabilities (special facilities are needed to make vaccines under strict sterile conditions) and limited supplies could hamper distribution of an approved vaccine. Many of the vaccine candidates must be shipped and stored at super-low temperatures, adding to the complexity. “Even if you have the vaccine, that doesn’t mean you can ship it out. There are multiple, multiple steps, and all of them have to work,” said Dr. Ezekiel Emanuel, a vice provost at the University of Pennsylvania who has warned of potential shortages. The National Academies of Sciences, Engineering and Medicine have issued a framework for who should get priority for the initial vaccine. State and local health departments will also have a say in how supplies roll out. Current recommendations say first in line will be health care workers and people with medical conditions that put them at highest risk if they get the virus. People living in nursing homes and other congregate settings will also be higher on the list. Further down are average healthy adults. Pay attention, and go when it’s your turn, said Schaffner. “If they say it’s time for people who are middle-aged and have chronic underlying illness such as diabetes, heart disease and lung disease, you have to know what you have and understand it’s your turn,” he said. “You also have to understand if it’s not your turn yet. Be patient.” Finally, many of the vaccines under consideration will require two doses spaced a few weeks apart, which would add to the delay. If more than one vaccine is approved, which is likely, people will need the second dose to come from the same manufacturer as the first. That could prove a record-keeping nightmare and lead to more delays — depending on how vaccine supplies hold up. In testimony before Congress in mid-September, CDC Director Robert Redfield said that tens of millions of doses of vaccine may start to become available by late November or December. But the logistics of vaccine distribution means the country won’t be able to return to “regular life” until “late second quarter, third quarter 2021,” Redfield predicted.

4. So don’t throw out your masks yet. Because any vaccine is likely to fall short of 100% effectiveness and won’t be in widespread distribution for a while, the use of masks and maintaining social distance will be required well into next year, experts say.

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“The vaccine will be a start, but we’ll still need to do the things we’ve been discussing throughout — hand hygiene, wearing masks and continuing to remain specifically distant,” said Dr. Krutika Kuppalli, an assistant professor of infectious disease at the Medical University of South Carolina. “Those are the arsenal of tools we will need to use.” 5. What if I don’t want to get vaccinated? Polls show a good percentage of Americans either don’t want a vaccine or want to wait a bit before getting one. Can they be required to get a shot? Certain employers, such as hospitals or food production plants, could require their workers to be vaccinated, but a federal mandate is highly unlikely and probably would be unconstitutional, said professor Dorit Rubinstein Reiss, an expert on employer and vaccine law at the University of California-Hastings College of Law. The likely approach of public health authorities is to educate people about the benefits and potential side effects of a vaccine — down to whether one might experience a sore arm. “That’s what we do for every vaccine,” said Adalja of Johns Hopkins. A requirement of vaccination for the general public would create resistance and “foster conspiracy theories,” he said. Most regulation of public health falls to state and local governments and health agencies, Reiss said. States would be “more likely to have narrow or specific mandates that could survive judicial review,” she said. Schools, of course, require students to be vaccinated against a wide range of illnesses. But a school-age COVID vaccine mandate is doubtful, at least in the near term, because the vaccine hasn’t been tested on school-aged children. Generally speaking, employers, including the federal government, have the power to require vaccinations, especially if they don’t have a unionized workforce with a contract that might limit their power. All employers, however, face limits set by civil rights and disability laws and may have to provide alternatives for people who can’t or won’t get vaccinated, Reiss said.

Julie Appleby, Senior Correspondent, reports on the health law’s implementation, health care treatments and costs, trends in health insurance, and policy affecting hospitals and other medical providers. Her stories have appeared in USA TODAY, The Washington Post, the Philadelphia Inquirer, MSNBC and other media. She serves on the board of the Association of Health Care Journalists and has a Master of Public Health degree.

How COVID-19 Spreads CDC | Updated Oct. 5, 2020 Source: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html

COVID-19 is thought to spread mainly through close contact from person to person, including between people who are physically near each other (within about 6 feet). People who are infected but do not show symptoms can also spread the virus to others. We are still learning about how the virus spreads and the severity of illness it causes.

COVID-19 spreads very easily from person to person How easily a virus spreads from person to person can vary. The virus that causes COVID-19 appears to spread more efficiently than influenza but not as efficiently as measles, which is among the most contagious viruses known to affect people.

COVID-19 most commonly spreads during close contact • People who are physically near (within 6 feet) a person with COVID-19 or have direct contact with that person are at greatest risk of infection. • When people with COVID-19 cough, sneeze, sing, talk, or breathe they produce respiratory droplets. These droplets can range in size from larger droplets (some of which are visible) to smaller droplets. Small droplets can also form particles when they dry very quickly in the airstream. • Infections occur mainly through exposure to respiratory droplets when a person is in close contact with someone who has COVID-19. • Respiratory droplets cause infection when they are inhaled or deposited on mucous membranes, such as those that line the inside of the nose and mouth. • As the respiratory droplets travel further from the person with COVID-19, the concentration of these droplets decreases. Larger droplets fall out of the air due to gravity. Smaller droplets and particles spread apart in the air.

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• With passing time, the amount of infectious virus in respiratory droplets also decreases.

COVID-19 can sometimes be spread by airborne transmission • Some infections can be spread by exposure to virus in small droplets and particles that can linger in the air for minutes to hours. These viruses may be able to infect people who are further than 6 feet away from the person who is infected or after that person has left the space. • This kind of spread is referred to as airborne transmission and is an important way that infections like tuberculosis, measles, and chicken pox are spread. • There is evidence that under certain conditions, people with COVID-19 seem to have infected others who were more than 6 feet away. These transmissions occurred within enclosed spaces that had inadequate ventilation. Sometimes the infected person was breathing heavily, for example while singing or exercising. o Under these circumstances, scientists believe that the amount of infectious smaller droplet and particles produced by the people with COVID-19 became concentrated enough to spread the virus to other people. The people who were infected were in the same space during the same time or shortly after the person with COVID-19 had left. • Available data indicate that it is much more common for the virus that causes COVID-19 to spread through close contact with a person who has COVID-19 than through airborne transmission.2

COVID-19 spreads less commonly through contact with contaminated surfaces • Respiratory droplets can also land on surfaces and objects. It is possible that a person could get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or eyes. • Spread from touching surfaces is not thought to be a common way that COVID-19 spreads

COVID-19 rarely spreads between people and animals • It appears that the virus that causes COVID-19 can spread from people to animals in some situations. CDC is aware of a small number of pets worldwide, including cats and dogs, reported to be infected with the virus that causes COVID-19, mostly after close contact with people with COVID-19. Learn what you should do if you have pets. • At this time, the risk of COVID-19 spreading from animals to people is considered to be low. Learn about COVID-19 and pets and other animals.

Protect yourself and others The best way to prevent illness is to avoid being exposed to this virus. You can take steps to slow the spread. • Stay at least 6 feet away from others, whenever possible. This is very important in preventing the spread of COVID-19. • Cover your mouth and nose with a mask when around others. This helps reduce the risk of spread both by close contact and by airborne transmission. • Wash your hands often with soap and water. If soap and water are not available, use a hand sanitizer that contains at least 60% alcohol. • Avoid crowded indoor spaces and ensure indoor spaces are properly ventilated by bringing in outdoor air as much as possible. In general, being outdoors and in spaces with good ventilation reduces the risk of exposure to infectious respiratory droplets. • Stay home and isolate from others when sick. • Routinely clean and disinfect frequently touched surfaces.

2 Pathogens that are spread easily through airborne transmission require the use of special engineering controls to prevent infections. Control practices, including recommendations for patient placement and personal protective equipment for health care personnel in healthcare settings, can be found in Section 2 of Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the COVID-19 Pandemic.

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Pandemics can be stressful, especially when you are staying away from others. During this time, it’s important to maintain social connections and care for your mental health.

The Road Ahead: Charting the coronavirus pandemic over the next 12 months — and beyond By Andrew Joseph Source: https://www.statnews.com/feature/coronavirus/the-road-ahead-the-next-12-months-and-beyond/

Sep 22 – Think back through the pandemic. Think about the moments that stand out as beacons in the haze — signposts of how it would change all of our lives. Not all of these moments were clear at the time. China’s decision to shut down cities of millions of people in January was staggering, but to most Americans, this new coronavirus remained an ocean away, not something that would demand our own version of a lockdown. Other moments form pits in our stomachs when we look back. Perhaps, for you, it’s when the Centers for Disease Control and Prevention touted it was developing its own test for SARS-CoV-2 instead of relying on international designs. Or when leaders in New York delayed containment plans as cases built. Or when President Trump embraced the unproven and ultimately fruitless hydroxychloroquine as a miracle drug. advertisement Then there were moments when the new reality arrived with the subtlety of a sonic boom. Take March 11: Trump halted most travel from Europe. Tom Hanks and Rita Wilson announced they had Covid-19. The NBA suspended its season. Now — with health authorities saying it may not be until at least the end of 2021 before there’s a degree of post-Covid normalcy in our lives — look forward. Imagine the next 15 months and what life will be like. In this project, STAT describes 30 key moments, possible turning points that could steer the pandemic onto a different course or barometers for how the virus is reshaping our lives, from rituals like Halloween and the Super Bowl, to what school could look like, to just how long we might be incorporating precautions into our routines. advertisement This road map is informed by insights from more than three dozen experts, including Anthony Fauci and Bill Gates, people on the frontlines at schools and hospitals, as well as STAT reporters. It largely focuses on the U.S. Perhaps making forecasts during what’s habitually described as “unprecedented” is foolish. “I’m kind of done predicting — none of my predictions worked out for me,” Kelly Wroblewski

www.cbrne-terrorism-newsletter.com 164 HZS C2BRNE DIARY – October 2020 of the Association of Public Health Laboratories said, with a resigned laugh, about when she thought the testing problems that have dogged us from the earliest days might get resolved. And indeed, some of the events will unfold in different ways and at other times than we’ve charted out. Yet for all that’s caught us off guard about Covid-19, some factors — like how a virus spilled from animals and swept around the world — are straight out of pandemic playbooks. We can see the coming crossroads. So many challenges still lie ahead. Flu season. An ongoing child care quandary. A tumultuous election and potential transition of power. Whoever wins, we’ll need them to shepherd a vaccine rollout — a logistical and public relations campaign without (here’s that word again) precedent. “The virus is not through with us yet,” said family physician and epidemiologist Camara Phyllis Jones of Morehouse School of Medicine. “The virus has only one job. And that’s to replicate itself, and to go from person to person to person — and it doesn’t care which person.” Throughout the pandemic, what’s maddened U.S. public health experts has been the nation’s inability and unwillingness to take the steps that could reduce illness and death, steps that other countries have used with success. Instead, we’re trying to force the activities — commerce, schools, and festivities — that controlling the virus in the first place would enable but that, in our case, are contributing to infection counts. “There’s this attitude that public health measures are getting in the way of opening up the country,” Fauci, the country’s most prominent infectious disease expert, told STAT. “It’s exactly the opposite. In a prudent way, the public health measures are the gateway, the vehicle, the pathway to opening the country. That’s the point that gets lost in this that’s so frustrating.” As Fauci monitors the coronavirus’ trajectory, so do the rest of us, wondering what other hallmarks the pandemic will soon touch — like Thanksgiving feasts. At Adams Turkey Farm in Westford, Vt., they’re anticipating this year selling fewer of their “signature” birds around 24 pounds — “Oh my gosh, they’re beautiful,” said owner Judy Adams — and more smaller birds. The holiday meal will still happen; there just might be fewer people squeezing around the table. “We’ve weathered different things — certainly not a pandemic — but I just trust in the holiday, I trust in the turkeys,” Adams said. “But if this is the year that we make less money, well, that will be OK, and we will get through this.”

Fall starts: Will it be wrenching, or really wrenching? Overstretched ambulance crews. Overflowing hospitals. Overstuffed morgues. The grimmest images from the spring and summer peaks could appear again this fall and winter if the country doesn’t drive its case count down urgently. “If we’re not going into the fall with a huge running start in terms of having cases at very, very low levels … we run the risk of having uncontrollable outbreaks,” said Michael Mina, an epidemiologist at Harvard’s T.H. Chan School of Public Health. People are returning to offices or schools and interacting with others more. Residents of the northern half of the country, who embraced al- fresco summers, will move indoors. States and cities are inclined to keep easing restrictions. Then there’s the virus itself. While this is our first fall with SARS-2, experts believe that its activity could accelerate as temperatures drop, as is the case with other viruses, including the four coronaviruses that cause common colds. These viruses survive longer in cold, dry settings, tied to a measure called absolute humidity. But the virus spread like gossip this summer in the South. Was the heat really slowing it down? To an extent, experts think. But whatever advantage summer provided was overtaken by the fact that none of us was protected against the virus, and that restrictions like closing bars were lifted. “The summer epidemic probably would have been worse if it had been winter,” said disease ecologist Marta Shocket of UCLA. Some communities will have one partial shield this fall: a level of population immunity. Most people who recover from Covid-19 will be protected from a second case for some time, it’s thought. In hard-hit areas, 20% of residents or more have had the illness already — many without knowing it — meaning fewer people can be infected and spread the virus.

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“We’re not dealing with a situation like we were in February and March when it was a totally naive population,” said epidemiologist Wafaa El-Sadr of Columbia University. These areas have not reached herd immunity — when the percentage of protected people is high enough that the spread burns out — but, El-Sadr said, “it’s a plus.” Mathematical epidemiologist Gerardo Chowell of Georgia State University has what could be considered an almost optimistic autumnal outlook: a flat number of cases, as increases in the northern half of the country offset declines in the South and some safeguards are kept up. But Chowell doesn’t imagine the real glass-half-full scenario: cases going down. “Having seen how U.S. society is split on face masks, I’m not very hopeful,” he said. It’s possible the fall won’t realize our worst fears. The flu season could be mild. Outbreaks in nursing homes and prisons could be prevented. But we’re approaching the danger zone with lots of virus circulating, when it was presumed that the country would be in a better position. Ahead of the fall, “we were envisioning that there would be a continued downward trajectory of Covid-19, new infections and deaths,” Brian Hainline, the NCAA’s chief medical officer, said in August. “That there would be a national surveillance system, national testing, and national contact tracing that would allow us to really navigate this pandemic and to resocialize both in sport and in the rest of society. And that hasn’t happened.”

Sept. 28: A college quarantine strategy faces the test For colleges, there’s one over-arching dilemma: How can they safely keep students on campus? As we look for clues, the University of Wisconsin-Madison is one to watch. Desperate to contain the virus, the school this month mandated that residents of two dormitories and 22 Greek houses quarantine for two weeks. “I literally felt like I was being arrested,” one student told a TV reporter. As the students emerge in the coming days, it will become clear whether the gambit worked. If it does, it could show that universities might be able to hem in the virus and slog through this semester. If it doesn’t, it might be a sign that more schools will have to throw in the towel, following the likes of Colorado College and the University of North Carolina in canceling their in-person plans after students showed up. Some schools have gone from in-person to virtual teaching and then given in-person another chance. College clusters are fueling a sizable portion of new Covid-19 infections around the country. But some schools are soldiering on: The University of Illinois at Urbana-Champaign and schools in New England, for example, have unveiled ambitious testing schemes. Some are holding lectures in basketball gyms or in tents. But colleges, by design, bring packs of people close together. If cases crop up, they easily beget more. And if one thing’s clear from the start of the semester, it’s that college kids like to party, Covid or not. “It would be pure luck if you didn’t have clusters of cases” at some point during the semester, said epidemiologist Nita Bharti of Pennsylvania State University. The colleges that allowed students to return did so in part because it’s what students wanted. They pleaded they were missing out on spontaneous 3 a.m. philosophical discussions and intellectual breakthroughs that come only after a group all-nighter. But for the schools, it was also a grasp at a financial lifeline as budgets collapsed. “Universities are in such a hard place,” said Meira Levinson, an educational ethicist at Harvard. “They are educating people who have the transmission patterns of adults but who are developmentally not making choices the way older adults would.” The deeper impact of college closures could come if schools don’t sequester students before sending them home. Absent that, they could spray the virus across the country like shrapnel.

Sept. 29: At first debate, Trump and Biden square off over Covid You can practically mouth the script: On stage at Case Western Reserve University in Cleveland (and before a limited audience), former Vice President Joe Biden

www.cbrne-terrorism-newsletter.com 166 HZS C2BRNE DIARY – October 2020 lambastes Trump for the nation’s disastrous pandemic response and for failing the American people. Trump tries to convince millions of viewers that the U.S. has turned a corner — that his administration defeated the virus and is this close to a vaccine. And with that, experts say, the election discourse poses real risks. Since the beginning of the pandemic, scientists have struggled to address Covid-19 misinformation from the administration. While they would normally advise looking to the Food and Drug Administration or CDC, the agencies at times have become megaphones for White House messaging. “We have offices that have credibility and we have noncredible people in those offices,” said Penn State’s Bharti. “That has created a disconnect for us for how to handle misinformation.” Trump’s attempts to paint a rosier picture of the situation could make it worse, experts say. If politicians prematurely declare victory, it sends the message that people no longer need to wear masks or distance from others. “I’m worried that if leaders say to the public like they did back in April or May, that this will be over, if those messages come back, it will confuse people again and we’ll see another surge in cases,” said Tom Inglesby, director of the Johns Hopkins Center for Health Security. “It’s really important for leaders not to sugarcoat things when they are not going well.”

Oct. 2: ‘A lost generation of workers’? Picture the cable news coverage of September’s unemployment report, a crucial proxy for the economy and the last one before the election. A flashing chart showing the pandemic’s toll on jobs, and an immediate pivot to the political implications. Trump will likely be watching. There had been hopes that the economy would bounce back from the depths of the spring in a V-shaped recession. Jobs returned as states allowed more business activity heading into the summer, but only to an extent, and hiring has since cooled. A bad or stagnant jobs report, then, could drive Trump to demand that states lift the remaining restrictions meant to keep a lid on Covid-19. But the central reason for the sputtering economy, economists say, is the uncontrolled epidemic. Government restrictions certainly dampened activity, but much of the persistent drag is because people do not feel safe traveling or hitting the town or spending money in their usual ways. “People look around and say, ‘the risks are too high, I’m not going to go about my activities,’” said economist Kosali Simon of Indiana University. This recession stands out for how quickly the economy cratered and for how it devastated select industries while leaving others unscathed. It’s also amplified the divide between white-collar workers who could slide into working from home, and lower-wage employees, many of whom lost their jobs or risked infection at their workplaces. The looming concern is that the pain may spread. Government spending has kept components of the economy treading water. If that support ends before a vaccine arrives, demand could collapse, unemployment could become long-term, and the recession could become entrenched. “We’re setting the stage for another decade of massive unemployment and a lost generation of workers,” said Harvard economist James Stock. A public health response is not only about saving lives, “it’s holding the economy in its hands.” The solution is not another lockdown, said Stock, who’s studying the effectiveness of interventions. Simple but sustained strategies, he said, can sufficiently drive infections down: donning masks, minimizing super-spreading opportunities, maintaining distancing, and restricting indoor activity. Build up testing. If cases get low enough, contact tracing becomes feasible. It’s essential that the country embraces these measures uniformly, Fauci said. “If one area in the country does it really well, and another area is careless and it surges up, that’s like playing whack-a-mole.”

Early October: After 100 million tests, it’s still not enough It’s too early to say we’ve overcome all the horrors of testing, from a CDC test that didn’t work to shortages of swabs and reagents to delayed (and thus meaningless) results.

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But, perhaps, finally, things are looking up. “A lot more ubiquitous testing is coming,” Ashish Jha, the dean of Brown University’s public health school, said at a STAT event in September. “I’ve been saying that for months, but maybe now it will actually be coming.” Faster and cheaper tests are becoming available, supported by a National Institutes of Health program. The Trump administration is distributing millions of antigen tests (which detect viral proteins) to nursing homes. Employers and universities have hatched ambitious testing strategies that could be models. A potentially more potent tool could also arrive in the coming months: rapid, at-home coronavirus tests, akin to pregnancy tests. This type of antigen test, which could use a saliva sample and is still in development, is not as accurate as PCR diagnostics (which detect the virus’ genetic material). But the vision is that it could offer individuals a pretty good clue as to whether they have infectious Covid- 19 within minutes — information that would allow them to go about their lives (with precautions) or isolate themselves. “Having a test that can find you when you’re transmissible is the whole goal,” Harvard’s Mina said. Still, plenty of challenges remain. Experts say testing capacity needs to be expanded many times over. Test kits abound on movie sets and in professional sports, yet many people still have trouble locating one. Whatever national testing strategy exists is defined by deferring to states, leaving local labs more vulnerable to supply chain snags and to getting overwhelmed. “The idea of what a rational testing plan looked like — you know, we were on the phone with all the key people in the federal government in those key months [February and March], and it just didn’t happen,” Bill Gates told STAT.

Mid-October: Can more K-12 schools get students back? Within two weeks of schools in Cherokee County, Ga., opening in August, when local coronavirus transmission was still high, more than 1,000 students and staff found themselves in quarantine and three high schools reverted to online learning. In the Northeast, as schools considered welcoming students for in-person instruction in September, communities generally had low Covid-19 rates — the surest signal that schools can reopen safely. But even there, last-minute snafus threw some plans into disarray, showing the difficulty of trying to hold together a strategy in a changing pandemic. New York City, which planned to open schools for a mix of classroom and remote learning Sept. 21, delayed for another week on Sept. 17. In Carle Place School District on Long Island, the superintendent made the call to switch to virtual learning two days before school started, after parties led to a spike in Covid-19 cases. “As we are learning the hard way, the actions of a few can impact the many,” Superintendent Christine Finn wrote in a letter to families. By mid-October, the northeastern schools that did welcome students back will be a month in — time for a report card on their strategies. Rhode Island, for example, opened schools in most districts, starting with some students as they moved toward full classes. There will also be signals whether schools that needed more time to get staff on board with in-person plans or to retrofit classrooms to meet safety standards can get kids back. Other countries have made it clear that low community transmission levels and rigorous strategies can enable schools to reopen and stay open. In a recent editorial in Science, researchers wrote that with distancing, limited classroom size, ventilation, and masks, “transmission within schools has been rare.” But in the U.S., schools haven’t been prioritized. In some places, movie theaters and gyms and indoor dining came back, even as local viral levels were deemed too high for in-person teaching. “We’re making choices that don’t necessarily make a lot of sense,” said Zoë McLaren, a health policy expert at the University of Maryland, Baltimore County. Cases will be detected at school, experts stress. The question is what happens then. Districts need plans for how extensive quarantines should be, how many cases would trigger a shutdown, and how long that should last. Returning to school, of course, is not just about the risk to kids, who are much less likely to get serious Covid-19 cases than adults. About 40% of teachers and 40% of adults living with children have health conditions that increase the likelihood of more severe Covid-19, according to one study. Many children live with a grandparent. Households have been key transmission points during the pandemic, and kids can’t isolate from their family. “If your kid gets sick, you’re probably going to get sick too,” said Maia Majumder, a computational epidemiologist at Boston Children’s Hospital.

Mid-October: SARS-2 treatments start to arrive The first treatments specifically crafted to fight SARS-2 could join clinicians’ armaments this fall.

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Called monoclonal antibodies, they are designed to block the virus from slipping into cells. A number of candidates are in clinical trials, with results possible starting in October. The real boon could be if monoclonals keep patients with mild Covid-19 from progressing to more severe illness. They are also in earlier-stage testing to see if they can stop infection, akin to a vaccine. “What we really need are therapies that can be administered early to prevent someone from actually needing to go to the hospital,” Fauci said. “That’s the big gap that we have.” When the pandemic erupted, the world’s medicine cabinet was bare of any coronavirus therapies. Researchers adapted, finding that an experimental antiviral called remdesivir helped hospitalized patients recover faster and that common steroids reduced deaths. They’re exploring blood thinners to stop clots, and ways to calm overhyped immune systems that paradoxically cause many patients’ deaths. And then there’s the still maybe-beneficial convalescent plasma — an antibody-rich blood component donated by people recovered from Covid-19. Monoclonals have been seen as providing a bridge for the pandemic — a treatment for patients who get sick while vaccines are being rolled out. But there are questions about whether their development will take too long to make a real impact. There hasn’t been a significant push, for example, to manufacture them en masse. “It makes sense for something like Ebola, sure, when there aren’t that many people” who get infected at a time, said Juliet Morrison, a University of California, Riverside, virologist. But with Covid-19, “can we scale up to really do that for the whole population?”

Oct. 22: The FDA’s vaccine advisory committee meets in a showdown over scientific integrity Usually, these meetings are eye-glazing to anyone beyond scientists and drug companies, yet another expert gathering in a conference room at the FDA’s suburban Maryland campus. But the topic will be Covid-19 vaccines, and given the timing — 12 days before the election — people nervous about potential White House interference in the FDA’s evaluations have this date circled on their calendars. At a routine meeting of these outside scientific advisers, the group might discuss the composition of that year’s flu shot or debate clinical trial data for a vaccine. At this one, it’s expected that results from Covid-19 vaccine candidates won’t be ready. Still, the (virtual) meeting could be a chance for the experts to build up a scientific bulwark against meddling from Trump — a moment when they will punctuate the importance of a rigorous review of immunizations, conducted only once adequate safety and efficacy data are available. “The medical science community must stop this dance as we get closer to rolling out a vaccine for Covid-19 because we now know that we won’t get any help from the federal government,” Holden Thorp, the editor-in-chief of the Science journals, wrote in an editorial. “We’re on our own.” FDA Commissioner Stephen Hahn has said that the meeting is part of the agency’s commitment to being “as open and transparent as possible” and that it will help the public understand “the data needed to facilitate [vaccines’] authorization or licensure.” Hahn has pledged that politics and pressure from the White House won’t force the agency’s hand. But the president has already accused the agency of harboring the “deep state” and slowing treatment development. He’s also staked his reelection on a vaccine, promising at the Republican National Convention that “we will produce a vaccine before the end of the year, maybe even sooner,” without mentioning the uncertainty around clinical trials.

Oct. 23: A vaccine gets a divisive FDA emergency authorization OK, so this one might not happen. But if it does, imagine the juxtaposition. A spike-the-football Trump tweet, and scientists fretting that a hastily released vaccine desecrated the regulatory process. To be clear, there is a small but legitimate possibility that, should one of the vaccine candidates be wildly effective, clinical trials could demonstrate that by the end of October. Executives at Pfizer have said they could have results by then. But most experts think that the requisite data won’t be available until later. Everyone involved in the vaccine review process, including the companies testing them, says they are committed to ensuring the safety and efficacy of immunizations. And yet … experts still can’t shake the feeling that something untoward might happen before the election. Call it an October surprise, pandemic style. Perhaps the FDA will try to thread the needle. Hahn has suggested a possible authorization for a vaccine for certain populations, such as health workers. But the great fear is that, if some issue emerges with a vaccine after it is authorized, it will only steepen the uphill climb

www.cbrne-terrorism-newsletter.com 169 HZS C2BRNE DIARY – October 2020 vaccine campaigns are facing. A not insignificant portion of Americans are dubious about Covid-19 vaccines. Unforced errors could only entrench their uneasiness. “If [the FDA] is bullied on this for vaccines, there are going to be a lot of people who stand up and say, ‘I wouldn’t get this vaccine.’ And then what you’ve done is you’ve scared people and you only get one chance to make a first impression,” Paul Offit, director of the Vaccine Education Center at Children’s Hospital of Philadelphia, said in August. Even if a vaccine meets the standards for an emergency use authorization, it might still raise eyebrows. “The track record of the FDA for EUAs with Covid has not been good,” said UMBC’s McLaren, citing the flip-flop on the hydroxychloroquine EUA and the politicization around the convalescent plasma EUA. “The endgame is not vaccine No. 1,” McLaren said, noting that the world will need multiple vaccines to have enough supply. “If trust in the EUA pathway is further damaged with vaccine No. 1, it’s going to hurt vaccines No. 2, 3, 4.”

Oct. 31: A scary Halloween indeed Parents, it may be time to have a difficult talk with your children. Los Angeles County has advised against trick-or-treating. Towns in Ohio have canceled public trick- or-treating events. And in Salem, Mass., a city of 43,000 that normally hosts a monthlong Haunted Happenings festival that welcomes half a million people, “pretty much all the events had to be canceled, rescheduled, or go virtual,” said Kate Fox of Destination Salem. Fox said people will still make the pilgrimage to Salem, but stressed that Massachusetts requires a negative Covid-19 test or a quarantine for people coming from most states.

Nov. 3: A momentous election indeed Perhaps nothing will change, or everything will. If Biden is elected, he has said his first post-election phone call would be to Fauci, with a request that the scientist continue his service. He has a plan to assemble a new team of health officials to guide the country out of the pandemic. If Trump is re-elected, don’t expect any major shifts in strategy. But it’s not Covid-19 policy differences driving voters, said Robert Blendon of Harvard, an expert on the intersection of politics and health policy. When it comes to the pandemic, voters are thinking pragmatically — how a Trump or Biden presidency would affect whether they can go to work and send their kids to school, or whether their businesses will survive. And, Blendon added, “What’s important to understand is that if there was some public health miracle in October, the polls would change dramatically.”

November: Covid, meet flu In 2018, so many people came down with the flu that Pennsylvania’s Lehigh Valley Health Network threw up tents to handle the influx of patients. In April of this year, the hospital almost had to turn operating rooms into ICUs for Covid-19 patients. The question for Lehigh Valley is: What would a double whammy look like? “My hope is that with all the education of the public, maybe it’s not as bad,” Jennifer Rovella, the system’s chief of critical care, said about the approaching flu season. It’s clear why experts worry about a wave of Covid-19 coinciding with a bad flu season — what’s been dubbed the twindemic. But it’s also possible that all the precautions against SARS-2 will reduce transmission of influenza; the Southern Hemisphere’s flu season, for instance, was remarkably mild. Health officials aren’t taking chances. They’re warning that people could get infected by both viruses, potentially making them more likely to get seriously ill. They’re pleading with the public to get flu shots, which, even if they don’t prevent infection, reduce the chances of severe disease. “We’ve ordered about twice the number of flu vaccines as we normally do,” said Rachel Levine, Pennsylvania’s health secretary. Beyond the threat to health systems, distinguishing between the infections will be a head- scratcher for clinicians. Flu and Covid-19 have overlapping symptoms, including cough, fever, and aches. Doctors often don’t even test for flu and diagnose a case based on an exam, but they won’t be able to do that this year. Some tests that detect both viruses are

www.cbrne-terrorism-newsletter.com 170 HZS C2BRNE DIARY – October 2020 being rolled out, but the urgency to tell if someone has flu or Covid-19 or both — with implications for isolation and contact tracing — could worsen bottlenecks. “You rely on the same laboratories and very similar testing supplies and equipment,” said the lab association’s Wroblewski.

Thanksgiving: Will holiday travel set us back? Can you break a wishbone over Zoom? The thought of people traveling for Thanksgiving and the December holidays, at the same time that college students who make it through the semester will be scattering home, makes experts anxious, to say the least. Still, some families will get together. The safest way would be for everyone to quarantine for two weeks and gather with people within driving distance. Whatever the plan, they’ll need to have the Covid version of “the talk”: sussing out exactly what risks others are taking — are they seeing friends? are they going to the gym? — and establishing ground rules for the weeks leading up to the holidays. “People like to think their friends and family are like them, and their risk behaviors are the same as mine, but so often that’s not true,” said Boston Children’s Majumder. Summer travel was down by 15%, the first decline since 2009, with air, rail, and cruise trips taking huge dives, according to AAA estimates. But with the virus potentially and silently piggybacking on travelers, even pared-back holiday journeys could seed new spread. Family gatherings pose specific risks. The number of contacts people have over the holidays drops from regular days, but as demographer Audrey Dorélien of the University of Minnesota said, “the age of those contacts changes.” People could pick up the virus at work or at school or among friends, and then, in addition to the gravy boat, pass it to grandma and grandpa.

Late November: The 250,000th American death When the official U.S. death toll hit 100,000, the New York Times dedicated its front page to the names of the dead. When it hit 200,000, Time put a black border on its cover for only the second time ever; the first was Sept. 11. How do you memorialize a quarter of a million Americans dead? “The numbers are so shocking compared to the numbers of people who are often commemorated on public monuments, like war dead,” said Kirk Savage, a professor of the history of art and architecture at the University of Pittsburgh. “That raises the question, if we’ve got more numbers, why aren’t we recognizing it?” We’ve grown a bit numb to the pandemic’s despair. We’ve cocooned ourselves from bad news, like we’ve trained ourselves to guard against SARS-2. But when the confirmed death count hits 250,000 (an undercount by some unknown amount), it might shake us out of our stupors. We’ll, for a time, consider the lives lost, and the family members who didn’t get to hug and kiss and hold their loved ones as they died. While the scale is difficult to comprehend, many have felt the impact. The staff at Carmon Community Funeral Homes in Connecticut faced an incredible sprint in March, April, and into May. They were arranging so many more funerals while adapting to

www.cbrne-terrorism-newsletter.com 171 HZS C2BRNE DIARY – October 2020 the strictures of the pandemic. Churches weren’t open, so they found other spaces for services. They webcast hundreds of funerals. The firm typically arranges about 1,500 funerals a year. “This year we will probably have served over 2,000 families,” said John Carmon. The death count will mean different things to different people. Some might compare it to historical milestones or scale it to other data points: five times the number of U.S. combat deaths in Vietnam, the equivalent of 500 747s crashing, more than 80 Sept. 11ths. Savage, who studies monuments, thinks that such a tragedy ultimately deserves a memorial. It might not be a statue or wall of names, but “something where people could congregate and mourn and just process what we have not been able to process.” However it’s commemorated, by the time the 250,000th death is recorded, the 250,001st death will be close behind.

Late November: 50,000 deaths among Black Americans The pandemic has rumbled through the U.S. like an excavator, digging up and magnifying generations-deep inequities. We’ve had to confront the fragility of access to housing, jobs, and health care. And no disparities have been more sobering than the fact that, according to data from APM Research Lab, Black, Pacific Islander, Indigenous, and Latino Americans all have age-adjusted Covid- 19 death rates triple that of white Americans. People of color “are more likely to get infected, and when we get infected, we’re more likely to die,” said Jones, the Morehouse epidemiologist. In the spring, for example, as much of the country’s attention was on Covid-19 in the Northeast, the infection rate in Navajo Nation eclipsed all others. Many people of color contracted the virus at work — risking exposure while trying to sustain their communities. Black transit drivers got other essential employees where they needed to go. Latino farm workers kept grocery stores stocked. “You cannot plant strawberries at your home,” said David Hayes-Bautista, director of UCLA’s Center for the Study of Latino Health and Culture. It’s not just infections that are falling unevenly. The recession is taking a greater toll on communities of color. Children of color are more likely to fall behind in school with virtual learning. In Louisiana, researchers found that even as the number of car crashes dropped during the shelter-at-home period, the share of drivers involved who were non-white increased — a sign, perhaps, of who was still going to work and who was doing all the deliveries for people at home. And it’s not just that Black and Latino Americans are dying at higher rates than white Americans from Covid-19 — they’re dying at younger ages. They are losing more years of life, are more likely to leave young children behind, and, Hayes-Bautista said, “it’s taking people out of their peak working and earning years.” It would be difficult to change the composition of the labor force on a dime, or quickly undo many of the other factors that explain Covid-19’s burden on communities of color. But that ignores that choices made during the pandemic, such as where testing sites were set up, created new roadblocks. And it elides the actions that experts say policymakers and employers could take right now to narrow the gap in infections and deaths: More testing in certain neighborhoods, better protective gear for workers, a more aggressive decarceration movement, offering places for people to isolate themselves if they get the virus, and continuing to pay people if they get sick so they stay home from work. There is progress around the edges — some meatpacking employees have gotten better PPE, for example — but experts don’t see changes happening to the extent necessary to winnow the gulf. “They could be done, but they’re not being done, because we’re not valuing all individuals and populations equally,” Jones said.

December: The results of crucial vaccine trials arrive Remember, one possibility is that a vaccine simply doesn’t work. But let’s say that some prove safe and effective (fingers crossed). The trials are generally testing whether vaccines reduce the chances of symptomatic Covid- 19. But experts will also examine the data to see if vaccines are blocking infections, how they work across age groups, and what side effects people might expect.

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“Is the vaccine preventing infection or is it functioning by reducing the severity of disease?” said biostatistician Natalie Dean of the University of Florida. “Is there any signal that it can reduce infectiousness if it’s not reducing infection entirely?” Then comes a presumably speedy FDA authorization, and the next challenge: Getting the shots to people. Public health experts have already been cobbling together an allocation blueprint for who should get vaccinated first. The U.S. government has been paying vaccine makers to manufacture doses before trials are completed, with supplies of ineffective products destined for the garbage. A behind-the-scenes distribution apparatus involving glass-vial producers, transportation logistics, and cold storage is revving up. It’s all to ensure there’s a supply of vaccine ready to go as soon as one is given the green light. Most experts agree that certain hospital workers and other frontline employees should be first to get vaccinated. Older people and those with underlying health conditions may come next. Some advocates are calling for prioritizing Black and Latino communities, on whom the pandemic has taken a disproportionate toll. Even as people are vaccinated, researchers will follow them to make sure there aren’t any surprise reactions and to determine when a booster might be required. “We don’t know how long protection is going to last,” said Inglesby, of Johns Hopkins. “We’re going to have to take the information as it comes and build the system as we go.”

Dec. 31: New Year’s Eve in a very different Times Square The pandemic has disrupted storied events, from the Olympics to the Radio City Rockettes’ Christmas Spectacular. Often, the cancellations include “for the first time since World War II.” While New Year’s Eve plans in Times Square haven’t yet been announced, it seems inevitable that the tradition will be far more restricted than even during the war. In 1942 and 1943, there was no ball drop “due to the wartime ‘dimout’ of lights,” according to the Times Square District Management Association. Still, crowds massed those years for a midnight “minute of silence followed by chimes ringing out from sound trucks.” Gathering like that could serve as a moment of camaraderie during a difficult time, but the pandemic is not like other historical crises. You wouldn’t want to start 2021 with Covid-19.

January 2021: One year after cases exploded in China A year after the coronavirus came to our attention, we’ll likely still have basic questions about it, including from which animals it leapt to people. But with time, we could start getting a better understanding of one of Covid-19’s biggest mysteries: how long immunity lasts. There’s not an exact answer. Some people, depending on how sick they get or something intrinsic to themselves, will be protected from reinfection longer than others. But when the bulk of people who recover from a first infection become susceptible again, it can change the dynamics of outbreaks. Protection from the coronaviruses that cause colds is thought to generally last about a year; immunity after SARS or MERS for a few years. If Covid-19 is like its cousins, come early next year, a wave of the pandemic’s earliest patients might see their immunity start to wane. If, as seems likely, an effective vaccine won’t be widely available, this could give the pandemic new fuel. It’s hypothesized, though, that people who get a second case will typically have milder illnesses and maybe won’t be as infectious. There have been a few cases of reinfection, but so far, these seem like outliers — scientific curiosities that gain headlines but that won’t shift the pandemic’s course. Overall, researchers are finding that most people generate a robust immune response to SARS- 2, one that seems to persist for at least several months. Maria Van Kerkhove, the World Health Organization’s technical lead for Covid-19, described this as “a very positive sign.”

Jan. 20: Masks or MAGA hats Whichever is the adornment of choice on the National Mall for the president’s inauguration could be a reflection of who won the election — and the future pandemic response. Traditionally, the inauguration speech, as well as the first presidential address to Congress, acknowledges the challenges of the past, with a more assured view of what is to come. In

www.cbrne-terrorism-newsletter.com 173 HZS C2BRNE DIARY – October 2020 this case, imagine a triumphant President Trump heralding that his administration steered the country through the worst of the pandemic, and was rewarded with a second term. A resolute President Biden would argue that now was the time to tend to the country’s wounds exposed by the pandemic, and to turn the moment into an opportunity for ambitious change. There is some potential overlap between what Trump or Biden would call for in their terms, like manufacturing more medicines and PPE domestically. Either president would have to oversee the rollout of vaccines and try to mount an economic recovery. But Trump’s pandemic strategy probably wouldn’t change, and he doesn’t seem likely to use the crisis to lead a new era of scientific discovery. Biden has a detailed pandemic plan that he hopes can start to pull the country out of the Covid-19 depths. But he would likely use the first speeches of his presidency to set loftier goals for shoring up the country’s pandemic preparedness. Experts and advocates have a lot of thoughts about what they would like the administration to do. More investments in science so we are more nimble for other emerging diseases. Appoint leaders who can begin to restore the credibility of the FDA and CDC among scientists and the public. Refurbish the national stockpile. Local health departments will have their own requests. The agencies never saw their budgets bounce back after the Great Recession and lost 55,000 positions from 2008 to 2017. They came into the pandemic already struggling to keep up with water-quality and restaurant inspections, childhood immunizations, addiction, and HIV testing. “We have to stop this approach where we fund the emergency only,” said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.

Feb. 7: Are you ready for some (fanless?) football? It’s the most-watched TV event every year, but the question will be how many fans will be watching at the game itself. When sports vanished at the outset of the pandemic, “it shook a lot of people,” said Patrick Rishe, director of the sports business program at Washington University in St. Louis. “There’s this identity and connection people feel toward their favorite athletes and teams.” So when the NBA, NHL, and MLB came back, it was a boon to fans — as well as the leagues’ finances. The leagues showed, with varying levels of success, that sports were possible in a pandemic. But those leagues did not allow spectators at games. Football has taken a different tack, with a handful of collegiate and professional teams welcoming thousands of (allegedly) masked fans into stadiums in the fall. A packed crowd at the Super Bowl would be an indication that the country had given up on trying to control the coronavirus, experts said; there’s just no way the virus will be so contained by early February. But experts say that allowing even some fans is a bad idea. “Being a big NFL fan myself — I have Seahawks season tickets — there’s no way I would feel safe attending a game or having my loved ones attend a game,” said Angela Rasmussen, a virologist at Columbia University. Teams limited capacity, required masks, and pointed out that, for the most part, the fans would be in outdoor stadiums. But those steps reduce — but don’t eliminate — the chance of transmission. Fans jostle past each other at concession stands and in bathrooms. And afterward, thousands of people scatter back to their hometowns.

March: One year after major U.S. outbreaks, will long-haulers have recovered? The more time passes, the more we’ll know about all that SARS-2 can do — and how long those effects last. “From an intellectual perspective, I’m fascinated” by the complexity of the coronavirus, said infectious disease expert Judith Feinberg of West Virginia University. “But from a public health perspective, I’m terrified.” Covid-19 quickly revealed itself to be much more than a respiratory infection. Kidney failure, heart damage, clogged blood vessels, and attacks on the nervous system have all resulted from the virus and the body’s attempts to fight it. It’s also caused a constellation of problems for “long-haulers” — those who recover from their acute illness but then experience a range of symptoms for, in some cases, months. Headaches, fatigue, muscle aches, and a “brain fog” that affects attention and memory are common. They have good days and debilitating days. It’s been a struggle to get doctors to take their concerns seriously.

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“Chronic symptoms after viral infections are not unheard of,” said Timothy Henrich, a viral immunologist at the University of California, San Francisco. “Although it certainly seems that with Covid-19, symptoms can be really persistent, more so than they would be for influenza or other upper respiratory infections.” After a presumed case of Covid-19 in April, with symptoms including chest tightness and headaches, Lynlee Swartz, 32, dealt for months with brain fog and a fatigue that left her so exhausted her family had to care for her German shepherd, Pepper. Her symptoms have started to improve, but the Indianapolis resident still gets tired. She’s accepted that she may not fully recover. “Yes, you have the two week respiratory infection, you have those people who are asymptomatic, and yes, you have those very, very severe cases,” she said. “But we need to normalize that there’s an entire spectrum of outcomes, including long Covid.” At Northwestern Memorial Hospital, researchers have started a clinic for patients experiencing neurological complications after Covid-19. Some patients had severe Covid-19, but not all. Some “are younger people, previously active and healthy, who had minor respiratory presentations with some fever that went away,” and then developed symptoms like dizziness and memory issues, said Igor Koralnik, an expert on the neurological effects of viral infections who is leading the clinic. Several factors could be at play. SARS-2 infects cells through a doorway called the ACE2 receptor, which is found in organs and blood vessels throughout the body. The infection itself could damage these tissues. A major driver, experts think, is that the body’s inflammatory response that revved up during the infection never quieted down. For some people, it can take time to restore that to normal. “We don’t have a full picture of this yet, and we do not understand the long-term effects for people with mild disease or even asymptomatic infections,” Van Kerkhove said.

March 19: Match Day illuminates how the pandemic has remodeled medicine In 2020, Match Day — when graduating medical students find out at which hospital, they’ve “matched” for their residencies — coincided with states and cities shutting down as the pandemic took off. The following month, Kelly Ieong, a student at Stony Brook’s medical school in New York, graduated early and joined the health care workforce facing a wave of patients. She spent two months on the Covid floors at Stony Brook’s hospital before starting her residency, taking care of intubated patients and having difficult conversations with their families. “Those two months were life-changing,” Ieong said. Ieong’s early departure from medical school was just one sign of how the pandemic has upended the fields of medicine and public health. For clinicians, “Covid for many has actually increased the sense of meaning, and for some, the sense of being valued by their patients, their colleagues, by the organization at which they work,” said Christine Sinsky, the American Medical Association’s vice president of professional satisfaction. “But on the other side of that are all the stresses that come from Covid — the fear of acquiring Covid yourself, or bringing it home to your family and friends.” More than 1,150 U.S. health workers have died from Covid-19. Perhaps the pandemic will be a galvanizing springboard for the public health workforce. All the attention on scientists — Fauci was even played by Brad Pitt on “Saturday Night Live” — could also inspire some future virologists and epidemiologists. At the same time, scientific expertise has been under attack by the public and politicians. Those days when we rallied around health workers are long past. It’s created what infectious disease physician Krutika Kuppalli called a “trauma to the global workforce.” In places that have had waves of Covid-19 patients, Kuppalli said, “where frontline workers have seen horrible things, we’re going to have mental health problems.” The pandemic arrived when there was already a shortage of infectious-disease physicians. Even top fellowship programs have had trouble for years filling their spots, as young physicians towing boatloads of debt were drawn into more lucrative specialties like cardiology. “It’s really quite alarming that we are having trouble recruiting people,” said Feinberg, a spokeswoman for the Infectious Diseases Society of America. “Covid shows you can’t run the world without us.”

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Freeman, the leader of the local health officials’ group, is not sure that the pandemic will motivate people to join health departments. It was already considered a thankless job. And with the virus, some leaders have even received death threats. “Maybe if we were able to handle it better, it could have been that inspiring type of event,” Freeman said. “And that’s really sad, isn’t it?” April 25: And the Oscar goes to … James Bond and Vin Diesel, who both know a thing or two about worldwide calamities, were clearly on to something. The next installments of the 007 and “Fast & Furious” franchises were among the first movies in March to postpone their planned release dates, for months or even a year. The pandemic has accelerated ongoing shifts in how people consume entertainment, putting a greater emphasis on at- home streaming services while providing a new threat to theaters, which were already increasingly dependent on blockbusters. So when the Oscars are given out — two months after the planned date — it likely won’t be the same awards show packed with celebrities. Theaters were closed for months as a result of government rules. But even as they started to open again in most places at the end of the summer, studios weren’t rushing to release their films. For lots of people, sitting in an enclosed space with dozens of others for hours does not sound like the escapism we normally seek from cinema.

April: Vaccines, round 2 The vaccine reinforcements could arrive starting in the spring. The first immunizations out of the gates into pivotal trials were from Moderna, AstraZeneca and the University of Oxford, and Pfizer and BioNTech. But other candidates just months behind could play a crucial role in corralling the pandemic. Of the shots that are authorized for use, some might work better in older people, who typically generate less robust immune responses to vaccines. The subzero temperatures at which some vaccines are stored might preclude their use in certain settings. The second group of immunizations might just be more effective than the pacesetters. And there’s the fact that the world just needs a whole bunch of doses. “There are over 7 billion people in this world and not one single company can make 7 billion doses of vaccine,” said Kawsar Talaat, a vaccine researcher at Johns Hopkins.

May: Celebrate good times, come on? Canceled. Postponed. Virtual. That was what happened in 2020 to traditional rites of spring, like proms, graduations, and the beginning of wedding season. For people planning events in 2021, it’s like trying to stare into a crystal ball if someone swapped it out with a shaken snow globe. They can’t tell if gatherings will be safe or if some people will have been vaccinated or if states will still have capacity limits. Memorial Day has also traditionally kicked off summer movie season, which vanished in 2020 but normally accounts for about 40% of annual box office revenue. Movie theaters have tried to make do by showing classics like “Jaws” and “Jurassic Park,” but the hope is that next summer will be full of the superheroes and sequels that normally attract theatergoers in droves. “They’re really just trying to get open and stay open,” said Phil Contrino, the director of media and research at the National Association of Theatre Owners. “If no new movies are opening, they can’t stay open.”

June: We need Americans ‘lining up to get the vaccine’ Finally, vaccines are widely available. Will Americans roll up their sleeves? The way out of the pandemic is to achieve herd immunity through vaccination, a point that will be reached for SARS-2, experts estimate, when some 50% to 70% of the population is protected. Health officials have been planning for months how to connect with hard-to-reach groups and people who don’t have regular access to care to ensure broad coverage. “We need to have people lining up to get the vaccine,” said Columbia’s El-Sadr.

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Polls, however, indicate widespread, and growing, skepticism about how quickly a safe and effective vaccine can be made available. People of color, who have long histories of mistreatment by the medical field, are even more leery. “The most effective vaccine in the world is useless if no one will accept it,” Talaat said. “I think people will die because of a lack of faith in the system.” She pointed to wavering CDC testing guidelines and the optics of political interference in FDA decisions as undermining the credibility of U.S. health agencies. Others say vaccine makers need to commit to being more transparent. “You can’t talk your way into trust,” Talaat said. “You need to demonstrate that you’re trustworthy, and that the process is trustworthy.”

July: As office employees return, what will greet them downtown? More than a year after companies en masse told office employees to work from home, more and more workers will come back. There’s been a lot of fretting over whether the pandemic is the death knell for some cities, and a lot of that is exaggerated. Covid-19 may contribute to ongoing trends of people fleeing eye-poppingly expensive cities, but that’s just a handful of metropolises. Still, there will be effects. Skyscrapers could face high vacancy rates. Cities that are particularly reliant on tourism or that were already on shaky footing could have a harder time recovering and have to cut services. People still crave density, but as Amy Liu, the director of the Metropolitan Policy Program at the Brookings Institution put it, the “geography of density” might change. Picture more commercial activity in the suburbs if people are working from home more often yet still want to hit happy hour. The inverse of that is, “your downtowns are not going to look the same,” Liu said. “All those small businesses, the food establishments and shops that depend on daytime traffic, a lot of that demand could go away.” Black-, Latino-, and immigrant-owned businesses are at particular risk because their customers are more likely to have lost jobs and income. When Bob Roberts, who runs McShane’s Irish Pub in the Corktown neighborhood of Detroit, assesses the pandemic’s toll, he takes a mental walk up the street. “We have a bagel shop that went out of business, we have a personal training and fitness company that went out, we have a hair salon that went out,” he said. With expanded outdoor dining and limited indoor capacity, most of the local restaurants have patched together a way to stay in business. But with winter coming and no sign that indoor capacity restrictions will be lifted, Roberts said, “it’s a really scary thought as to what might happen.” The pandemic could also decimate a core feature of urban living: public transit. Agencies are projecting shortfalls in the billions of dollars, as ridership and sales tax crashed. They could have to cut routes and delay upgrades. All this will have a particular impact on low-income residents and people of color, who make up the majority of transit passengers.

July 6: The U.S. withdraws from the WHO — maybe Whether the U.S. goes through with its plan to leave the WHO depends on the election. A President Biden would reverse Trump’s decision to withdraw. But if Trump wins reelection and pulls the U.S. out of the United Nations agency, effective July 6, 2021, it will have deep ramifications for the WHO’s funding and programs, cooperation among scientists, and even how prepared the U.S. will be for flu seasons. Beyond the U.S. decision, the WHO is in the middle of a review of its handling of the pandemic. The agency typically launches such assessments once a crisis ebbs, but the pressure on the agency — drummed up by the U.S. — has been so great that an independent panel started meeting in September, with a report due in 2021. Criticisms of the agency include that it was deferential to China in the early days of the pandemic, when more aggressive action could have stemmed outbreaks, but WHO observers say the crisis has underscored how policies set by member states keep it from taking a stronger hand in reprimanding countries.

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July 23: The 2020, erm 2021, Olympics begin in Japan Fans heading to the Olympics will need passports, luck if they want to snag tickets to see Simone Biles compete, and — perhaps? — proof of vaccination. By summer, the hope is that millions upon millions of people will have received Covid-19 vaccines. But this embodiment of global kinship could come at a time when national interests are overriding distribution to all countries. When vaccines make it to the market, the initial supply will be extremely limited relative to global demand. Wealthy countries have taken an us-first approach by trying to snap up millions of doses. Advocates have argued that the world won’t be safe and that global travel and economic patterns won’t return until the virus is smothered everywhere. “Vaccine nationalism will prolong the pandemic, not shorten it,” WHO Director-General Tedros Adhanom Ghebreyesus said in September. Ultimately, the gulf in vaccine access could humble wealthy countries into helping others. “Large parts of the world will not have been vaccinated by a year from now,” Brown’s Jha said at the STAT event in September. “And it will create substantial political and social tensions to see high-income countries starting to get back to normal when you see a lot of people in low- and middle-income countries continue to get infected and die from the disease.”

August through December, and beyond: Living with SARS-2 Let’s start with what won’t happen to the coronavirus: It gets wiped off the earth. The only human disease ever eradicated was smallpox. SARS-2, it seems, has joined the ranks of endemic viruses. But if vaccination coverage reaches all corners of the world, Covid-19 could become an uncommon disease, eventually a rare one. Pockets of people may remain vulnerable if they never build up immune memory to the virus — either through infections or vaccines — so serious cases may still occur. But for most people, even if they contract SARS-2, that immune memory should make each subsequent infection milder and milder — perhaps imperceptibly so. So, when will we reach that point? So much depends on when vaccines are authorized and how quickly they can be deployed. But most experts say that even if a vaccine campaign gets rolling at the beginning of 2021, certain precautions like masks might be our future until at least 2022. “Normal” won’t just arrive one day. We’ll work our way toward it. “We will have to, as societies around the world, learn to live with this infection,” said Jeremy Farrar, the director of the Wellcome Trust. “Manage it. Reduce its impact through vaccination, treatment, and diagnostics as we do with other infections.” “This is with us for a very long time — with a vaccine or without a vaccine,” he added. That is not a message people will want to hear. But the important thing to remember, Fauci said, is that the crisis “will end.” People need to remember that their choices matter to protecting themselves and others. “When you realize it’s not an infinite problem, you can feel better about just hanging in there a bit longer,” Fauci said. If the pandemic is not static, neither is SARS-2. So far, it doesn’t seem mutations have dramatically changed the virus, but modifications in its RNA could alter how it infects, transmits, and sickens, and how effective vaccines are. “The evolutionary dynamics are still kind of inscrutable — we don’t know what’s going to go on

www.cbrne-terrorism-newsletter.com 178 HZS C2BRNE DIARY – October 2020 there,” said Sarah Cobey, an epidemiologist and evolutionary biologist at the University of Chicago. SARS-2 was the third coronavirus to raise global alarms in less than 20 years. Despite that, “we were so poorly prepared for this it was ridiculous,” said Stanley Perlman of the University of Iowa, one of a handful of U.S. scientists with a decades-long coronavirus focus. Perlman suggested that researchers should set out to develop antiviral drugs that work against coronaviruses broadly. Fauci raised the possibility of a universal coronavirus vaccine. A SARS-CoV-3 or MERS-CoV-2 could appear at any point. “The thing about coronaviruses is that they really like crossing species,” Perlman said. The pandemic will have lasting impacts, on everything from people postponing having children to urban landscapes to harms to global health. But “we will come through on the other side and we will go back to our lives,” said Howard Markel, a historian of medicine at the University of Michigan. “There have been epidemics for millennia, and those who survive move on with their lives and they go on.” Perhaps by the holidays in December 2021, life will feel safe enough that memories of the anxiety and fear of spring 2020 start to blur. After all, Markel said, the typical final act of health emergencies is “global amnesia,” when people forget the lessons of what they just lived through. But surely the Covid-19 pandemic has been so monumental that things will change, right? “I sure hope so,” Markel said. “If this one doesn’t do it, I don’t know what will. But my study of the past suggests to me that we may not, and we would do so at our own peril.” It’s not just pandemic preparedness, of course. Covid-19 has been like a blacklight on U.S. society, revealing in glaring detail the faults that are built into its foundations. The real test will be whether that clear view drives change, or whether the country flips the light off once again.

Credits Story: Andrew Joseph - a general assignment reporter at STAT. He previously worked for the San Antonio Express- News, the San Francisco Chronicle, and the National Journal. Andrew graduated from Dartmouth College and has covered everything from crime to health policy. He's run a couple marathons, and one time got called out by Arnold Schwarzenegger at a press conference for asking a question that made no sense. Additional reporting: Helen Branswell, Sharon Begley, Damian Garde Illustrations: Mike Reddy Story Editor: Gideon Gil Art Direction: Alissa Ambrose Web Development: Jen Keefe, Corey Taylor, Tony Guzmán Copy Editor: Sarah Mupo

Could the Live Flu Vaccine Help You Fight Off COVID-19? Source: https://www.npr.org/sections/health-shots/2020/10/08/917831035/could-the-live-flu-vaccine-help-you-fight-off-covid-19

Oct 09 – In case you were still procrastinating getting a flu shot this year, here's another reason to make it a priority. There's a chance the vaccine could offer some protection against COVID-19 itself, says virologist Robert Gallo, who directs the Institute of Human Virology at the University of Maryland School of Medicine and is chairman of the Global Virus Network. The key is getting the right flu vaccine, says Gallo, who was one of the main scientists credited with discovering HIV. "The vaccine has to have a live virus in it. The virus is attenuated so it doesn't cause disease, but otherwise the virus is alive." A live virus may sound a bit terrifying, but it's a standard way to make safe and effective vaccines. In fact, you've probably already had a few "live, attenuated" vaccines in your lifetime, such as the measles vaccine or oral polio vaccine. Now scientists are just beginning to learn that these vaccines may offer some unexpected advantages to the immune system. When developing a vaccine, scientists have a few strategies to try. They can take a piece or component of the bacteria and use that to trigger an immune response in a person. They can kill the pathogen and use its corpse as the vaccine. Or they can take a live pathogen and weaken it in the lab. The latter are called "live, attenuated vaccines," and over the past century, scientists have noticed something peculiar about these vaccines: They seem to offer some protection, not just from the targeted disease, but also against many different diseases, including respiratory infections.

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"There's plenty of evidence for it," Gallo says. "The weakness is we don't really know the longevity [of the protection]. It will probably work only for months, but we can't say for sure." Take for instance, the vaccine for tuberculosis. It's called bacille Calmette-Guerin, or BCG, and it contains a live, but weakened, strain of TB from cows. When doctors in Sweden first started using BCG back in the 1920s, they noticed not only that the vaccine reduced a child's risk from dying of TB, but also that children who got it had a mortality rate from all causes that was almost three times lower than unvaccinated children. Since the 1970s, scientists in West Africa have documented a similar pattern with both the BCG vaccine and the live measles vaccine. In other words, the vaccines were doing something to boost the immune system's response to many kinds of pathogens. Recently, doctors in the Netherlands directly tested the BCG vaccine against a placebo, to see if it could help volunteers fight off a weakened form of yellow fever. The conclusion? People who received the BCG vaccine mounted a stronger immune response against the virus and cleared out the virus more effectively than those who received the placebo, the study reported.

The nasal spray version of the flu vaccine contains live but weakened form of the virus. Researchers think there's a good chance this could help boost the body's immunity and improve its ability to fight off pathogens such as the coronavirus. Tim Sloan/AFP via Getty Images

It's not just BCG that seems to have this effect. There's growing evidence that any live vaccines can offer some broad, nonspecific protection, including the oral polio vaccine, measles and the live flu vaccine. Scientists have had a hard time believing the evidence because the idea goes against the way they thought vaccines work, says immunologist Zhou Xing at McMasters University in Ontario. "It's a new concept that has emerged in the field of immunology over the past five to 10 years or so." In general, vaccines work by tricking the body to produce antibodies. These molecules are very specific. They typically target and n eutralize only one type of infection. Live vaccines also work through antibodies, but they likely do something else, as well. They supercharge our body's front-line defenders — the cells that first recognize an invader and try to clear it out before the infection gets out of control, Zhou says. Specifically, scientists think live vaccines epigenetically reprogram immune cells in the bone marrow, called myeloid cells. Unlike antibodies, myeloid cells are nonspecific — they work on many types of invaders. And they work quickly when the virus first enters a person's body. Now the big question is: Will live vaccines help a person clear out the coronavirus from their body before they get sick or before the infection becomes severe? To figure that out, scientists around the world are currently running more than a dozen clinical trials with both BCG and the live polio vaccine to see whether they offer some protection against the virus that causes COVID-19. No one believes the protection will be as strong — or as long-lived — as that provided by a specific COVID-19 vaccine, says Dr. Moshe Arditi, who leads one of the trials at Cedars Sinai in Los Angeles. But, he says, the BCG vaccine has several advantages to a specific vaccine. It's cheap. A dose only costs a few dollars. And we already know it's safe. "More than 130 million kids every year — every year — receive the BCG vaccine so the safety profile has been very strong," Arditi says. So, the BCG vaccine could be approved — and available — by early next year, he says. "It could be a bridge until we have a safe, effective COVID-19 vaccine." In the meantime, virologist Robert Gallo says, why not go get the live flu vaccine, if you can? This year, the flu vaccine comes in two major forms: a shot or a nasal spray. The shot, which is approved for all people above age 6 months who don't have contraindications, contains an inactivated virus or components of the virus. The nasal spray (FluMist), which is approved for people ages 2 to 49, contains live, attenuated flu viruses. "You watch," Gallo says. "People who get the live flu vaccine will also be protected against the COVID-19. That's the hypothesis."

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However, even if you get a vaccine, you should still exercise all the same cautious you would otherwise: Wear a mask, keep your distance, wash your hands and avoid large indoor gatherings.

EDITOR’S COMMENT: BCG will be approved in the country that the entire planet is waiting to produce the Covid-19 vaccine!

Here's the First Thing You Need to Do if You Think You've Been Exposed to COVID- 19

President Trump is Correct: We Can Have a Coronavirus Vaccine Approved Soon – and It Will Be Because of Science By Gregory Rummo Source: https://townhall.com/columnists/gregoryrummo/2020/10/11/president-trump-is-correct-we-can-have-a-corona-virus- vaccine-approved-soon--and-it-will-be-because-of-science-n2577833

Oct 11 – It was one week after the terrorist attacks on 9/11 when envelopes containing a white powder began showing up at random locations in four states; among them, a newspaper office in Florida, the Washington D.C. office of then-Senate Majority Leader Tom Daschle, NBC News and the New York Post. The white powder turned out to be anthrax spores, engineered to be readily dispersed and inhaled – a potentially deadly bioterrorism weapon. Anthrax infections are treated with antibiotics. There are two that are most effective; ciprofloxacin and doxycycline. At that time, I was the CEO of a small pharmaceutical company that represented foreign API manufacturers in the US. We had a large, domestic customer base to which we marketed dozens of anti-infective agents, including antibiotics. Doxycycline was one of them. We had been working with Zenith Laboratories, a generic pharmaceutical manufacturer in South Florida (currently a part of Teva Pharmaceuticals) to approve our doxycycline for use in its formulations. Normally, the turn-around time for the FDA to approve a drug, even a generic copy of an existing drug (which doxycycline was), is well over a year and often two. But this was different. The US was facing a crisis in the form of a potential bioterrorism attack. The federal government’s response to anthrax quickly became a national emergency. Zenith Laboratories, along with other manufacturers was awarded a contract to supply tablets and capsules to the Department of Defense’s Strategic National Stockpile. In less than one month, the Food and Drug Administration granted an emergency use authorization and we became approved suppliers of doxycycline. Over the ensuing months, our logistical challenge was to supervise the manufacture and delivery of as much API as possible to Zenith Laboratory’s manufacturing sites in the US and Puerto Rico. When the crisis finally subsided, we had delivered close to 200 metric tons (200,000 Kg) of doxycycline. Fortunately, anthrax never became the bioterrorism threat many had feared. Five people died as a result of coming into contact with envelopes contaminated with the spores that had been delivered through the postal system. Our government’s coordinated response in 2001 to apply pressure to drug manufacturers and its own Food and Drug Administration to expedite approval of a life-saving treatment for a bioterrorism weapon bears an eerie similarity to the national health crisis in which we find ourselves. Yet, I don’t recall President George W. Bush ever coming under attack for pressuring the FDA to rush an approval and putting the safety of the nation at risk. Any drug, be it an antibiotic, an antiviral, a monoclonal antibody cocktail or a vaccine goes through a rigorous, scientific process long before ever falling into the hands of government regulators, let alone politicians. Drug development begins with a conceptual design model followed by research, engineering, small-scale manufacturing and several phases of testing; usually first in animals and then humans. Failures are common along every step of this process. By some estimates over 90 percent of drugs never make it to market.

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Any drug or therapeutic must demonstrate efficacy and safety before the FDA will approve its use in the general public. So, what do we know about the efficacy and safety of two of the leading mRNA coronavirus vaccines currently in development by Pfizer and Moderna? Both companies are well into their Phase 3 clinical trials. Moderna is testing its vaccine on 30,000 people nationwide. In September, Pfizer expanded its Phase 3 cohort to 44,000. Moderna reported positive results in mid-July from the Phase 1 study of its mRNA-1273 vaccine which “induced anti–SARS-CoV-2 immune responses in all participants, and no trial-limiting safety concerns were identified.” In August, Pfizer reported similar findings: “7 days after a second dose of 30µg, BNT162b2 elicited SARS-CoV-2–neutralizing geometric mean titers (GMTs) in younger adults (18-55 years of age) that were 3.8 times the GMT of a panel of 38 sera of SARS- CoV-2 convalescent patients, and in older adults (65-85 years of age) the vaccine candidate elicited a neutralizing GMT 1.6 times the GMT of the same panel, demonstrating strong immunogenicity in younger and older adults.” To date, both vaccines have demonstrated safety and the ability to generate antibodies to the coronavirus at multiples higher than patients that had recovered from an infection.

With any new technology, there is always risk During the Manhattan Project when the US tested its first atomic bomb, there was the fear that the explosion would begin a chain reaction and “ignite Earth's atmosphere… destroy[ing] the planet.” In the name of science, we lost one crew of Apollo astronauts and almost lost a second. We also lost two crews aboard Space Shuttles. There are stories of others who have taken risks to advance science. In contrast, there have been no reports of death or even grave illness arising among volunteers involved in either the Pfizer or the Moderna mRNA vaccine Phase 3 trials. Early on, Moderna reported that there were “adverse events… in more than half the participants includ[ing] fatigue, chills, headache, myalgia, and pain at the injection site,” during Phase 1 trials. But these were with the highest dosage, which has since been modified for its ongoing Phase 3 trials. In late August, Pfizer reported similar positive findings on its second mRNA vaccine candidate, developed to reduce adverse effects from its initial vaccine candidate but providing the same immune response. It has been more than two months since these trials began. Candidates have by now received their first and second booster injections and have provided blood samples to researchers. I am confident that both companies’ trials will continue to show efficacy and safety. It is no stretch of the imagination to believe we can and should have coronavirus vaccines approved under the FDA’s emergency authorization use as early as next month for distribution to, at the very least, healthcare workers and those most at risk of severe morbidity. This is not politics but, in fact, the result of science – lots of science – and shame on those politicians who continue to make this an issue of anything but.

Gregory J. Rummo is a Lecturer of Chemistry at Palm Beach Atlantic University and a Contributing Writer for The Cornwall Alliance for the Stewardship of Creation. He is the former CEO of New Chemic US Inc and patient 001 in Moderna’s mRNA-1273 Phase 3 trial currently being conducted at the Palm Beach Research Center in West Palm Beach, FL.

Cnew research on SARS-CoV-2 virus 'survivability' Source: https://www.eurekalert.org/pub_releases/2020-10/ca-nro100920.php

Oct 11 – Researchers at CSIRO, Australia's national science agency, have found that SARS-CoV-2, the virus responsible for COVID- 19, can survive for up to 28 days on common surfaces including banknotes, glass - such as that found on mobile phone screens - and stainless steel. The research, undertaken at the Australian Centre for Disease Preparedness (ACDP) in Geelong, found that SARS-CoV-2: survived longer at lower temperatures tended to survive longer on non-porous or smooth surfaces such as glass, stainless steel and vinyl, compared to porous complex surfaces such as cotton survived longer on paper banknotes than plastic banknotes.

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Results from the study The effect of temperature on persistence of SARS-CoV-2 on common surfaces was published in Virology Journal. CSIRO Chief Executive Dr Larry Marshall said surface survivability research builds on the national science agency's other COVID- 19 work, including vaccine testing, wastewater testing, Personal Protective Equipment (PPE) manufacture and accreditation, and big data dashboards supporting each state. "Establishing how long the virus really remains viable on surfaces enables us to more accurately predict and mitigate its spread, and do a better job of protecting our people," Dr Marshall said. "Together, we hope this suite of solutions from science will break down the barriers between us, and shift focus to dealing with specific virus hotspots so we can get the economy back on track. "We can only defeat this virus as Team Australia with the best Australian science, working alongside industry, government, research and the Australian community." Dr Debbie Eagles is Deputy Director of ACDP, which has been working on both understanding the virus and testing a potential vaccine. "Our results show that SARS-CoV-2 can remain infectious on surfaces for long periods of time, reinforcing the need for good practices such as regular handwashing and cleaning surfaces," Dr Eagles said. "At 20 degrees Celsius, which is about room temperature, we found that the virus was extremely robust, surviving for 28 days on smooth surfaces such as glass found on mobile phone screens and plastic banknotes. "For context, similar experiments for Influenza A have found that it survived on surfaces for 17 days, which highlights just how resilient SARS-CoV-2 is." The research involved drying virus in an artificial mucus on different surfaces, at concentrations similar to those reported in samples from infected patients and then re- isolating the virus over a month. Further experiments were carried out at 30 and 40 degrees Celsius, with survival times decreasing as the temperature increased. The study was also carried out in the dark, to remove the effect of UV light as research has demonstrated direct sunlight can rapidly inactivate the virus. "While the precise role of surface transmission, the degree of surface contact and the amount of virus required for infection is yet to be determined, establishing how long this virus remains viable on surfaces is critical for developing risk mitigation strategies in high contact areas," Dr Eagles said. Director of ACDP Professor Trevor Drew said many viruses remained viable on surfaces outside their host. "How long they can survive and remain infectious depends on the type of virus, quantity, the surface, environmental conditions and how it's deposited - for example touch vs droplets emitted by coughing," Professor Drew said. "Proteins and fats in body fluids can also significantly increase virus survival times. "The research may also help to explain the apparent persistence and spread of SARS-CoV- 2 in cool environments with high lipid or protein contamination, such as meat processing facilities and how we might better address that risk."

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Fantastic photos!

Researchers at UAE university develop portable testing kit that can detect Covid- 19 in 35 minutes Source: https://www.thenational.ae/uae/health/researchers-at-uae-university-develop-portable-testing-kit-that-can-detect-covid-19- in-35-minutes-1.1091187

Oct 10 – A team of researchers at Abu Dhabi’s Khalifa University have developed a promising new testing kit that can detect coronavirus in 35 minutes. The portable device, which is slightly larger than a smartphone, is undergoing clinical validation. So far, the results have proven to be as accurate as a PCR nasal swab test, the method currently used to identify the virus in patients.

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The reusable kit can test 16 different samples at one time, the colour of which changes depending on the result. Starting mid-October, we will be doing saliva tests, and hopefully, in the very near future we'll be able to detect coronavirus using saliva samples The process involves a loop-mediated isothermal amplification (Lamp) technique, which is a low-cost method to detect certain diseases. “Polymerase chain reaction or PCR testing is lengthy and requires bulky equipment,” said said Dr Anas Alazzam, associate professor in mechanical engineering at Khalifa University and primary investigator of the kit. “It uses a thermal cycling approach to start the RNA replication process, which needs to be converted to DNA and detect the virus. “Lamp, on the other hand, uses a single temperature approach to get the same results. “It can be conducted on a single device and the process is much faster.” Initially, the kit took 45 minutes to deliver results, including 15 minutes to prepare the sample and 30 minutes to test it. This month, researchers working on the kit were able to reduce the preparation time to five minutes, bringing down the total time to detect coronavirus to just 35 minutes. “We use a colorimetric detection method. When the test is complete, an alarm sounds and we see a change of colour in the samples,” said Dr Alazzam. “Yellow represents a positive case and pink represents a negative case. “We started working on this device in May and so far, we have tested only nasal swabs. “Starting mid-October, we will be doing saliva tests, and hopefully, in the very near future we'll be able to detect coronavirus using saliva samples.” The hand-held device, which was designed and 3D-printed at Khalifa University, is 25 centimetres long and seven centimetres wide. The team is currently working to reduce its size further. “Once the device is clinically validated and we receive approval from the government, we can begin its mass production,” said Dr Alazzam. “The device could be used at home, in offices as well as for rapid testing of frontline workers. “We could even use it to screen passengers at the airport or on board a plane.”

Engineer Says Where You Sit in a Room Can Influence Your Risk of Catching COVID-19 By Suresh Dhaniyala Source [+video]: https://www.sciencealert.com/where-you-sit-in-a-classroom-might-influence-your-risk-of-contracting-covid-19

Oct 11 – It doesn't take long for airborne coronavirus particles to make their way through a room. At first, only people sitting near an infected speaker are at high risk, but as the meeting or class goes on, the tiny aerosols can spread. That doesn't mean everyone faces the same level of risk, however.

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As an engineer, I have been conducting experiments tracking how aerosols move, including those in the size range that can carry viruses. What I've found is important to understand as more people return to universities, offices and restaurants and more meetings move indoors as temperatures fall. It points to the highest-risk areas in rooms and why proper ventilation is crucial. As we saw this past few weeks with President Donald Trump and others in Washington, the coronavirus can spread quickly in close quarters if precautions aren't taken. University campuses have also been struggling with COVID-19. Cases among 18- to 22-year-olds more than doubled in the Midwest and Northeast after schools reopened in August. As the case numbers rise, the risk to anyone who spends time in those rooms rises as well.

An experiment shows who's at greatest risk Most current models describing the role of ventilation on the fate of airborne microbes in a room assume the air is well mixed, with the particle concentration uniform throughout. In a poorly ventilated room or small space, that is likely true. In those scenarios, the entire room is a high-risk region. However, in larger spaces, such as classrooms, good ventilation reduces risk, but likely not uniformly. My research shows that how high the level of risk gets depends a lot on ventilation. To understand how the coronavirus can spread, we injected aerosol particles similar in size to those from humans into a room and then monitored them with sensors. We used a 30-foot by 26-foot university classroom designed to accommodate 30 students that had a ventilation system that met the recommended standards. When we released particles at the front of the classroom, they reached all the way to the back of the room within 10 to 15 minutes. However, because of active ventilation in the room, the concentrations at the back, about 20 feet (6.1 metres) from the source, were about one-tenth of the concentrations close to the source. That suggests that with appropriate ventilation, the highest risk for getting COVID-19 could be limited to a small number of people near the infected speaker. As the time spent indoors with an infected speaker increases, however, risk extends to the entire room, even if ventilation is good. CDC finally acknowledges the aerosol risk In the past, the transmission of respiratory diseases has focused on the role of larger particles that are generated when we sneeze and cough. These droplets fall quickly to the ground, and social distancing and mask wearing can largely prevent infection from them. The bigger concern now is the role of tiny particles known as aerosols that are generated when we talk, sing or even just breathe. These particles, often smaller than 5 micrometers, can escape from cloth face masks and linger in air for up to about 12 hours. The Centers for Disease Control and Prevention finally acknowledged that risk on October 5 after Trump was hospitalized and several other people in or close to the administration tested positive for COVID-19. While these smaller particles, on average, carry less virus than larger particles that people emit when they cough or sneeze, the high infectivity of SARS-CoV-2 combined with the high viral load before symptoms appear makes these particles important for airborne disease transmission.

How much ventilation is enough? To minimize COVID-19 transmission indoors, the CDC's top recommendation is to eliminate the source of infection. Remote learning has effectively done this on many campuses. For face-to-face teaching, engineering measures such as ventilation, partition shields and filtration units can directly remove particles from the air. Of all the engineering controls, ventilation is probably the most effective tool to minimize infection spread. Understanding how ventilation lowers your risks of getting COVID-19 starts with air exchange rates. An air exchange of one per hour means that the air supplied to the room over one hour equals the volume of air in the room. Air exchange rate ranges from less than one for homes to around 15-25 for hospital operating rooms. For classrooms, the current regulations of primary air flow correspond to an air exchange of about six per hour. That means that every 10 minutes, the amount of air brought into the room equals that of the volume of the room. How high the concentration gets depends in part on the number of people in the room, how much they emit and the air exchange rate.

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With social distancing reducing classroom populations by half and everyone wearing masks, the air in many indoor spaces is actually cleaner now than it was before the pandemic.

Parts of the room to avoid It's important to remember that not all parts of a room are at equal risk. The corners of the room will likely have a lower air exchange – so particles can linger there longer. Being close to an air exit vent could mean that airborne particles from the rest of the room could wash over you. A study of ventilation airflow in a restaurant in China traced its role in several COVID-19 illnesses among the patrons there. About 95 percent of particles in the room will be removed by a properly functioning ventilation system in 30 minutes, but an infected person in the room means those particles are also continuously emitted. The pace of particle removal can be accelerated by increasing the air exchange rate or adding other engineering controls such as filtration units. Opening windows will also often increase the effective air exchange rate. As schools, restaurants, malls and other communal spaces start accommodating more people indoors, understanding the risks and following the CDC's recommendations can help minimize infection spread. This story has been updated with the CDC's newly released guidance on aerosols.

Suresh Dhaniyala, Bayard D. Clarkson Distinguished Professor of Mechanical and Aeronautical Engineering, Clarkson University.

Johnson & Johnson pauses Covid-19 vaccine trial after 'unexplained illness' October 13, 2020

The company did not say what the unexplained illness was, but one point of clinical trials is to find out if vaccines cause dangerous side effects. Trials are stopped when they pop up while doctors check to see if the illness can be linked to the one-dose vaccine or is a coincidence.

Lower Plasma Zinc Levels Associated with Increased Risk of Death in COVID-19 Patients Source: https://www.medscape.com/viewarticle/938793

Oct 08 – New research presented at the 2020 ESCMID Conference on Coronavirus Disease (ECCVID – 23-25 September 2020) suggests that lower levels of baseline plasma zinc are associated with poorer survival outcomes in patients hospitalised with COVID- 19. The study by Dr Roberto Güerri-Fernández, Hospital Del Mar, Barcelona, Spain, and colleagues, involved a retrospective analysis of symptomatic COVID-19 patients admitted to a tertiary university hospital in Barcelona, Spain from 15 March to 30 April 2020. Fasting plasma zinc levels were measured routinely at admission in patients admitted to the COVID-19 unit and computer modelling and statistical analyses were used the assess the impact of zinc on mortality. Mean baseline zinc levels among the study cohort of 249 patients was 61 mcg/dl. Among those who died (n=21, 8%), baseline zinc levels were significantly lower at 43mcg/dl vs 63.1mcg/dl in survivors. Having a plasma zinc level lower than 50mcg/dl at admission was associated with a 2.3 times increased risk of in-hospital death (95% CI 1.06-5.01; P=0.034) compared with the patients with a plasma zinc level of 50mcg/dl or higher. Higher zinc levels were associated with lower maximum levels of interleukin-6 during the period of active infection. After adjusting by age, sex, severity and receiving hydroxychloroquine, multivariable regression showed each unit increase of plasma zinc at admission to hospital was

www.cbrne-terrorism-newsletter.com 187 HZS C2BRNE DIARY – October 2020 associated with a 7% reduced risk of in-hospital mortality (0.93, 95% CI 0.89–0.98; P=0·0049).

Expert commentary Question: What are the potential clinical implications of your research? Güerri-Fernández: "We have submitted a paper with this work and some in vitro studies that demonstrate that zinc has some clinical implications in virus control. I believe that if these results are confirmed further studies with zinc supplementation could be done. Moreover, some studies have already been done with zinc and respiratory infections. Probably those patients with lower levels are the ones that would benefit the most."

 This article originally appeared on Univadis.com.

Trump Got Therapies You Wouldn't Get -- And You're Better Off By F. Perry Wilson Source: https://www.medscape.com/viewarticle/938541

Oct 06 – At the time of this recording, on October 5, the President of the United States is still hospitalized at Walter Reed Medical Center for COVID-19. According to press releases, he is doing relatively well despite some transient hypoxemia. Despite that, according to his personal physician, he has received the following medications: • Remdesivir • Melatonin • Zinc • Famotidine • Aspirin • Vitamin D • A monoclonal antibody cocktail from Regeneron under compassionate use • And, most recently, dexamethasone If you looked at this treatment regimen not knowing the patient, you'd assume that this was someone on the brink of death — ventilated. Last-ditch-effort time. Of course, the president doesn't seem to be particularly sick. Let's face it: If you or I had COVID and were as sick as the president, there is no way we would be getting this kind of treatment. And here's the thing: We're probably better off. Right now, the president might be the victim of a well-described medical phenomenon called the VIP syndrome. When I was early in my training, a "very important person" was admitted to our hospital. I can't tell you this person's name, but trust me — a VIP. So at some point during his care, he needed a chest tube pulled. The chief of cardiothoracic surgery came to do the honors. Before we went in, he turned to us and commented, "The last time I pulled a chest tube was 15 years ago." See, the person you want to pull your chest tube is the third-year resident, the one who does it 10 times a day. But the VIP gets the chief of the whole department. Ironically, VIPs often get worse care. First described by Walter Weintraub in 1964, VIP syndrome is nothing new. Our first president, in fact, may have been a victim.

Life of George Washington: The Christian, lithograph by Claude Regnier, after Junius Brutus Stearns, 1853. Gift of Mr and Mrs Robert B. Gibby, 1984 [WB-55/A1], Washington Library, Mount Vernon, Virginia.

On December 13, 1799, George Washington at age 67 was struck with some type of bacterial epiglottitis. Over a 12- hour period, he was subjected to four blood-letting procedures — state-of-the-art medicine

www.cbrne-terrorism-newsletter.com 188 HZS C2BRNE DIARY – October 2020 at the time — for a total of 80 oz of blood. That's 2.5 L of blood loss. He succumbed on December 14 shortly after gentlemanly thanking his doctors for their exceptional efforts. To be fair, the VIP syndrome is really one of anecdotes. Few rigorous studies have tried to evaluate the phenomenon. Nevertheless, case reports and case series appear across a variety of medical journals in psychiatry, in medicine. Even the vaunted New England Journal of Medicine touched on the aspects of emergency care for the VIP patient in 1988. I don't envy the physicians taking care of the president. What are you supposed to do? We don't know the full details of his condition, but assuming that he was mildly ill, standard of care would basically be symptomatic relief. If he was hypoxemic, you could probably make an argument for steroids based on the RECOVERY trial. Remdesivir as well, provided that there was some evidence of lower respiratory involvement. But the antibody cocktail? A drug that you can only get through compassionate use? That isn't standard of care. We don't even have a phase 2 publication on this cocktail yet, much less a phase 3 trial. There's this published study in macaques that seems promising. But whatever you think of the president, he is not a macaque. What we know of the Regeneron cocktail right now comes from a press release that tells us of outcomes in just under 300 patients, showing that — at least among those with poor native antibody responses — viral load decreased faster with the cocktail. Okay. But with that few people, do we really understand the risks? Monoclonal antibodies have a long history, but strange reactions can occur: allergy to the product, off-target effects. You know the drill. Look, I'm not going to go hardcore egalitarian here. If we had a magic pill that cured COVID with no side effects but cost $10 million, sure — give it to the president even though the rest of us can't get it. The unfairness is not really what the VIP syndrome is about. It's the risk the VIP faces getting medications — and combinations of medications — that we don't know enough about. Doctors know that standard care is the best care. That's why it's standard. The Hail Mary pass is for the fourth quarter when your team is about to lose; it's not your opener. But for VIPs, these essential truths get forgotten. I can imagine what these docs are thinking, though. What if the president worsened? What if the president died? Wouldn't you, as a physician, want to say that you did absolutely everything you could have possibly done? This reveals a bias in medicine that often does more harm than good: the need to do something, or in this case, to do everything, even when the data don't yet support it. Because you don't want to be on the hook for a bad outcome. But bad outcomes could happen because of this aggressive treatment. If the president has a rare reaction to the antibody cocktail — say he develops some autoimmune response — the physicians who treated him could be rightly criticized. But you know what? I doubt they will be. Our bias is so strong in favor of treatment that if that rare event happened, we would brush it off as a risk that had been worth taking to save this particular life. Of course, in the end, everyone deserves the best possible care. What's ironic is that because he is the president, Donald Trump may be receiving worse care than you or I would. Sometimes it's good to be a nobody.

F. Perry Wilson, MD, MSCE, is an associate professor of medicine and director of Yale's Program of Applied Translational Research. His science communication work can be found in the Huffington Post, on NPR, and here on Medscape.

Lockdowns Are a Step Too Far in Combating Covid-19 By Joe Nocera Source: https://www.bloomberg.com/opinion/articles/2020-10-13/lockdowns-are-a-step-too-far-in-combating-covid-19

Oct 13 – D.A. Henderson was a remarkable man. An expert in bioterrorism, dean of what is now the Johns Hopkins Bloomberg School of Public Health and frequent adviser to U.S. presidents, Henderson was best known as the man who eradicated smallpox in the 1970s. His knowledge of infectious diseases was unsurpassed. In the mid-2000s, when the U.S. public health community was trying to devise a program to fight pandemics, Henderson, who died in 2016 at the age of 87, was in the thick of it. The 9/11 attacks had given rise to fears of bioterrorism, and President George W. Bush, having read John M. Barry’s book about the 1918 pandemic, “The Great Influenza,” was pushing public health officials to come up with a preparedness plan that could be put into action if a new virus took hold.

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Some proposed interventions, such as frequent hand-washing, contact tracing and quarantining the sick, were uncontroversial. But one intervention was the subject of furious debate: lockdowns. They hadn’t been used as a pandemic response since the Middle Ages. On one side of the debate were the scientists who had been asked by the Bush administration to come up with the pandemic response. They favored lockdowns. On the other side was Henderson. In a paper he wrote in 2006 with three colleagues, Henderson concluded that lockdowns were likely to do far more harm than good and would “result in significant disruptions of the social functioning of communities and result in possible significant economic problems.” What’s more, they added, there was simply no evidence that lockdowns reduced the toll of a contagious virus. Henderson lost that debate, obviously. But now, seven months into the current pandemic, it would appear that the world is coming around to his point of view. The economic damage wrought by lockdowns has been immense. School closings have done incalculable damage to students, especially poor ones. This summer, some 20% of the U.S. workforce was on unemployment, according to Forbes. The question of whether lockdowns have saved any lives remains as unsettled today as it was in 2006. Last week, Dr. David Nabarro, the World Health Organization’s special envoy on Covid-19, was interviewed by the U.K.’s Spectator TV. In the early days of the coronavirus, the WHO had been an important advocate of lockdowns, and much of the world followed its advice. Yet when the host, Andrew Neil, asked Nabarro about lockdowns, he replied: We in the World Health Organization do not advocate lockdowns as the primary means of controlling this virus. The only time a lockdown is justified is to buy you time to reorganize, regroup, rebalance your resources, protect your health workers who are exhausted. … Look at what is happening to poverty levels. It seems that we may well have a doubling of world poverty by next year. We may have at least a doubling of child malnutrition. … Remember, lockdowns just have one consequence that you must never ever belittle, and that is making poor people an awful lot poorer. Without acknowledging that this was a shift in its original position, Nabarro said that the WHO is now advocating what he called a middle path — “holding the virus at bay while keeping economic and social life going.” This would require a high level or organization by governments and engagement by citizens. It would mean significant contact tracing, isolating those who have come in contact with an infected person and taking mask-wearing and social distancing seriously. “If we can combine these steps,” Nabarro said, “we can get in front of it.” No doubt he is right. Sadly, in the U.S. right now, getting that kind of government organization and buy-in by the populace is virtually impossible — not as long as Donald Trump is president and millions of Americans refuse to take even the most basic measure of wearing a mask. Even so, should there be a significant second wave of the coronavirus, another lockdown would be a terrible mistake. In addition to the economic damage and disruption it would cause, it would also bring about enormous resistance. And it would create even more distrust in the government’s pandemic advice. Just ask the people living in the New York hot spots that Governor Andrew Cuomo put into lockdown recently. They are in open revolt. The truth is that using lockdowns to halt the spread of the coronavirus was never a good idea. If they have any utility at all, it is short term: to help ensure that hospitals aren’t overwhelmed in the early stages of the pandemic. But the long-term shutdowns of schools and businesses, and the insistence that people stay indoors — which almost every state imposed at one point or another — were examples of terribly misguided public policy. It is likely that when the history of this pandemic is told, lockdowns will be viewed as one of the worst mistakes the world made. “Experience has shown that communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted,” Henderson and his colleagues wrote in that 2006 paper. “Strong political and public health leadership … are critical elements. If either is seen to be less than optimal, a manageable epidemic could move toward catastrophe.” We should have been listening to him all along.

Joe Nocera is a Bloomberg Opinion columnist covering business. He has written business columns for Esquire, GQ and the New York Times, and is the former editorial director of Fortune. His latest project is the Bloomberg-Wondery podcast "The Shrink Next Door."

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Eight Persistent COVID-19 Myths and Why People Believe Them By Tanya Lewis October 12, 2020 Source: https://www.scientificamerican.com/article/eight-persistent-covid-19-myths-and-why-people-believe-them/

○ 1 The virus was engineered in a laboratory in China. Because the pathogen first emerged in Wuhan, China, President Donald Trump and others have claimed, without evidence, that it started in a lab there, and some conspiracy theorists believe it was engineered as a bioweapon. ⚫ Why It’s False: U.S. intelligence agencies have categorically denied the possibility that the virus was engineered in a lab, stating that “the Intelligence Community ... concurs with the wide scientific consensus that the COVID-19 virus was not man- made or genetically modified.” Chinese virologist Shi Zhengli—who studies bat coronaviruses and whose lab Trump and others have suggested was the source of COVID-19—compared the pathogen’s sequence with those of other coronaviruses her team had sampled from bat caves and found that it did not match any of them. In response to calls for an independent, international investigation into how the virus originated, China has invited researchers from the World Health Organization to discuss the scope of such a mission. ⚫ Why People Believe It: People want a scapegoat for the immense suffering and economic fallout caused by COVID-19, and China—a foreign country and a competitor of the U.S.—is an easy target. Accidental lab releases of pathogens do sometimes occur, and although many scientists say this possibility is unlikely, it provides just enough legitimacy to support a narrative in which China intentionally engineered the virus to unleash it on the world.

○ 2 COVID-19 is no worse than the flu. Since the beginning of the pandemic, Trump has lied about the disease’s severity, saying it is no more dangerous than seasonal influenza. Trump himself admitted to journalist and author Bob Woodward in recorded interviews in early February and late March that he knew COVID-19 was more deadly than the flu and that he wanted to play down its severity. ⚫ Why It’s False: The precise infection fatality rate of COVID-19 is hard to measure, but epidemiologists suspect that it is far higher than that of the flu—somewhere between 0.5 and 1 percent, compared with 0.1 percent for influenza. The Centers for Disease Control and Prevention estimates that the latter causes roughly 12,000 to 61,000 deaths per year in the U.S. In contrast, COVID-19 had caused 200,000 deaths in the country as of mid-September. Many people also have partial immunity to the flu because of vaccination or prior infection, whereas most of the world has not yet encountered COVID-19. So no, coronavirus is not “just the flu.” ⚫ Why People Believe It: Their leaders keep saying it. In addition to his repeated false claims that COVID-19 is no worse than the flu, Trump has also said—falsely—that the numbers of deaths from COVID-19 are exaggerated. In fact, reported deaths from COVID-19 are likely an undercount.

○ 3 You don’t need to wear a mask. Despite a strong consensus among public health authorities that masks limit transmission of coronavirus, many people (the president included) have refused to wear one. Georgia’s governor Brian Kemp went so far as to sign an executive order banning city governments from implementing mask mandates. He even sued Atlanta’s mayor Keisha Lance Bottoms when she instituted one, although he has since dropped the lawsuit. Nevertheless, as coronavirus cases spiked around the U.S. during the summer, even states that were once staunch holdouts implemented mask orders. ⚫ Why It’s False: Masks have long been known to be an effective means of what epidemiologists call source control (preventing a sick patient from spreading a disease to others). A recent analysis published in the Lancet looked at more than 170 studies and found that face masks can prevent COVID-19 infection. It has also been widely established that people can be infected with and spread COVID-19 without ever developing symptoms, which is why everyone should wear a mask to prevent asymptomatic people from spreading the virus. ⚫ Why People Believe It: Early guidance on masks from the CDC and the WHO was confusing and inconsistent, suggesting that members of the general public did not need to wear masks unless they had symptoms of an infection. The guidance was in part driven by a shortage of high-quality surgical and N95 masks, which the agencies said should be reserved for health care workers. Even though face coverings are now mandated or recommended in many states, some people refuse to wear one because they consider it emasculating or a violation of their civil liberties.

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○ 4 Wealthy elites are using the virus to profit from vaccines. In a book and in the conspiracy theory film Plandemic, Judy Mikovits, who once published a high-profile but eventually retracted study on chronic fatigue syndrome, makes the unsubstantiated claim that National Institute of Allergy and Infectious Diseases director Anthony Fauci and Microsoft co-founder Bill Gates could be using their power to profit from a COVID-19 vaccine. She also asserts without evidence that the virus came from a lab and that wearing masks “activates your own virus.” An excerpt from the film was widely shared by anti-vaxxers and the conspiracy theory group QAnon. The video was viewed more than eight million times on YouTube, Facebook, Twitter and Instagram before it was taken down. ⚫ Why It’s False: There is no evidence that Fauci or Gates has benefited from the pandemic or profited from a vaccine. In fact, Fauci has sounded alarms throughout the pandemic about the risks of the virus, and Gates has a long history of philanthropy geared toward eliminating communicable diseases. Mikovits’s claims about the virus’s origin and the efficacy of masks also have no scientific support. ⚫ Why People Believe It: Wealthy or influential figures such as Gates and Fauci are often the target of conspiracy theories. Trump has at times attacked Fauci, a member of his own coronavirus task force, calling him an “alarmist.” Some of the president’s followers may find it more palatable to believe that Fauci is exaggerating the severity of the outbreak than to acknowledge the Trump administration’s failure to contain it.

○ 5 Hydroxychloroquine is an effective treatment. When a small study in France suggested the malaria drug hydroxychloroquine might be effective at treating the disease, Trump and others seized on it. The study is now widely criticized, but some people have continued to tout the medication despite growing evidence that it does not benefit COVID-19 patients. In a tweet, Trump called the hydroxychloroquine treatment “one of the biggest game changers in the history of medicine,” and he has mentioned it repeatedly in his public coronavirus briefings, continuing to hype the drug. In late July he retweeted a video featuring Stella Immanuel, a Houston, Tex.–based physician (who has made questionable assertions in the past, including that doctors had used alien DNA in treatments and that demons cause certain medical conditions by having sex with people in their dreams), claiming that hydroxychloroquine is an effective treatment for COVID-19. The video was viewed tens of millions of times before social media companies took it down. ⚫ Why It’s False: Several studies have shown that hydroxychloroquine does not protect against COVID-19 in those who are exposed. The Food and Drug Administration initially issued an emergency use authorization for the drug, but the agency later warned against its use because of the risk of heart problems and ultimately revoked its authorization. And in June the National Institutes of Health halted its clinical trial of the medication, stating that although it was not harmful to patients, it did not provide any benefit. ⚫ Why People Believe It: Initial reports suggested hydroxychloroquine might be a potentially promising drug, and people are most likely to believe the first things they learn about a topic, a phenomenon called anchoring bias. And because Trump has repeatedly claimed that the drug is effective, his supporters may be more likely to believe reports that confirm their views rather than those that challenge them.

○ 6 Increases in cases are the result of increased testing. As coronavirus cases surged in the U.S., Trump frequently claimed that the spikes were merely the result of more people being tested. He has tweeted that “without testing ... we would be showing almost no cases” and has said in interviews that the reason numbers appear to have gone up is that testing has increased. ⚫ Why It’s False: If this scenario were true, one would expect the percentage of positive tests to decrease over time. But numerous analyses have shown the opposite. The rate of positive tests rose in many states (such as Arizona, Texas and Florida) that had big outbreaks this past summer, and it decreased in states (such as New York) that controlled their outbreaks. In addition, hospitalizations and deaths increased along with cases, providing more evidence that the national increase in positive tests reflected a true increase in cases. ⚫ Why People Believe It: There was a severe shortage of tests in the U.S. early on during the pandemic, and their availability has increased (although actual testing remains far short of what is needed). It is logical to wonder whether more cases are simply being detected—if you look only at total cases and not at the proportion of positive tests or the rates of hospitalization and death.

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○ 7 Herd immunity will protect us if we let the virus spread through the population. Early on in the pandemic, some speculated that the U.K. and Sweden were planning to let the coronavirus circulate through their populations until they reached herd immunity—the point at which enough people are immune to the virus that it can no longer spread. (Both nations’ governments have denied that this was their official strategy, but the U.K. was late to issue a full lockdown, and Sweden decided against widespread restrictions.) ⚫ Why It’s False: There is a fundamental flaw with this approach: experts estimate that roughly 60 to 70 percent of people would need to get COVID-19 for herd immunity to be possible. Given the high mortality rate of the disease, letting it infect that many people could lead to millions of deaths. That tragedy is what happened during the 1918 influenza pandemic, in which at least 50 million people are thought to have perished. The U.K.’s COVID-19 death rate is among the world’s highest. Sweden, for its part, has had significantly more deaths than neighboring countries, and its economy has suffered despite the lack of a shutdown. ⚫ Why People Believe It: They want to get back to normal life, and without a widely available COVID-19 vaccine, the only way to achieve herd immunity is to let a substantial number of people get sick. Some have speculated that we may have already achieved herd immunity, but population-based antibody studies have shown that even the hardest-hit regions are far from that threshold.

○ 8 A COVID-19 vaccine will be unsafe. Worrying reports have emerged that many people may refuse to get a COVID-19 vaccine once it is available. Conspiracy theories about potential vaccines have circulated among anti-vaxxer groups and in viral videos. In Plandemic, Mikovits falsely claims that any COVID-19 vaccine will “kill millions” and that other vaccines have done so. Another conspiracy theory makes the ludicrous assertion that Gates has a secret plan to use vaccines to implant trackable microchips in people. Most Americans still support vaccination, but the few voices of opposition have been growing. A recent study observed that although clusters of anti-vaxxers on Facebook are smaller than pro-vaccination groups, they are more heavily interconnected with clusters of undecided people. One Gallup poll found that one in three Americans would not get a COVID-19 vaccine if it were available today and that Republicans were less likely to be vaccinated than Democrats. ⚫ Why It’s False: Vaccines save millions of lives every year. Before a vaccine is approved in the U.S., it must generally undergo three phases of clinical testing to show that it is safe and effective in a large number of people. The top COVID-19 vaccine candidates are currently being tested in large-scale trials in tens of thousands of people. ⚫ Why People Believe It: There is good reason to be cautious about the safety of any new vaccine or treatment, and the politicization of the fda under the Trump administration has raised legitimate concerns that any vaccine approval will be rushed. Nevertheless, previous safety trials of the top vaccine candidates did not find major adverse effects; larger trials for safety and efficacy are now underway. Nine pharmaceutical companies developing vaccines have pledged to “stand with science” and not release one unless it has been shown to be safe and effective.

Tanya Lewis is an associate editor at Scientific American who covers health and medicine.

Second COVID-19 Trial Paused Over Safety Concerns Oct 14 – US pharmaceutical firm Eli Lilly on Tuesday suspended its Phase 3 trial of its lab-produced antibody treatment in hospitalized patients over an unspecified incident.

A pandemic pod could help you get through winter, experts say. Here’s how to form one. Source: https://www.washingtonpost.com/lifestyle/wellness/pandemic-pod-winter-covid/2020/10/14/214ed65c-0d63-11eb-b1e8- 16b59b92b36d_story.html

Oct 14 – At this point in the novel coronavirus pandemic, Americans have largely accepted that returning to life pre-2020 is not likely to happen any time soon. But that hasn’t stopped many from trying to reestablish a sense of normalcy by maintaining social connections while

www.cbrne-terrorism-newsletter.com 193 HZS C2BRNE DIARY – October 2020 still being mindful of the public health guidelines intended to slow the spread of the deadly virus. One method that has gained popularity in recent months is forming a pandemic pod or bubble. Also known as a “quaranteam,” the strategy has been adopted by a number of families — especially those with young children — and close-knit friend groups. It requires people in the pod to follow strict safety protocols, such as mask-wearing and social distancing, when they are in public or interacting with others outside the group. Ideally, pod members can then socialize together in person in settings where the rules can be relaxed, without increased risk of contracting or spreading the virus. By managing risk while allowing social interaction, this approach is a way to “really support mental health and emotional health and the other aspects of human connection that are just really important right now,” said Melissa Hawkins, an epidemiologist and director of the Public Health Scholars Program at American University. And as the weather gets colder, making outdoor gatherings less feasible, experts say assembling a pod may be a way to ride out the pandemic winter without having to give up in-person interactions. Here are their tips for how to navigate the complex process of “podding up.”

Thoroughly assess potential pod mates Choosing people to form a pod with is “a little bit like dating,” said Carolyn Cannuscio, director of research at the University of Pennsylvania’s Center for Public Health Initiatives. “We have to assess people’s risk tolerance and their exposures,” said Cannuscio, a social epidemiologist. “One thing the pandemic is making plain to me is that there is a wide range of behaviors that people consider safe.” It is critical to ask prospective pod mates a number of questions about their daily routines, ranging from their grocery shopping habits to whether they are frequenting bars and restaurants, Cannuscio said. But she noted that the simplest metric to base an assessment on is how many people the person has face-to-face contact with in a typical day or week. Then, she said, try to choose friends or family members who have similar numbers of these daily interactions that you do. You should be prioritizing people you can trust, said John O’Horo, an infectious-disease specialist with the Mayo Clinic in Rochester, Minn. “The most important thing in my mind is just trying to think about who are those individuals who I trust with my safety and they would trust me with theirs,” O’Horo said. “Don’t be afraid to be selfish when you’re thinking about that. The people who you might consider your good friends aren’t necessarily the people who you would trust in this situation.” Pod mates should not be “casual friends,” Cannuscio said, adding, “These have to be people you can share very intimate conversations with.” Expect to talk regularly about the “minutia of daily life” and be willing to be open about your health and any potential exposures with the rest of the group, she said. Cannuscio also emphasized the importance of making sure you actually like spending time with the people in your pod.

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“Listen to your intuition about the relationships you have with all the members of the pod,” she said. “If your intuition tells you that someone is going to rub you the wrong way, they will really rub you the wrong way as winter sets in and we’re locked into these pods.”

Keep your pod small There are no formal guidelines for the ideal number of people you should recruit for a pod, but experts say the smaller the group the better. “Every additional person you’re adding to your pod is increased risk for the whole group,” said Michael Knight, an assistant professor of medicine at George Washington University. “For every additional person, there is a greater chance that someone may be exposed.” He suggested trying to limit your pod to five to 10 members. A good gauge of whether your pod has gotten too large is if you are unable to quickly determine who is and isn’t in it, O’Horo said. “You should be very aware of who’s in and they should be able to list you as well.”

Agree on clear rules for members to follow A pod or “quaranteam” should not be thought of as a “casual designation” for a group of people you occasionally enjoy spending time with, Hawkins said. “This is really a commitment to a long-term way of navigating in this unusual world and navigating it safely together.” This means a pod needs to establish rules and standards that all members agree to follow, which should guide their behavior both inside and outside the group. Pods should at least require people to closely adhere to recommendations from the Centers for Disease Control and Prevention and their local public health authority when out in public or engaging with nonmembers, Knight said. That could include avoiding extended nonessential social interactions with anyone not in your pod, Cannuscio said. “The pact that people are making when they form a pod is to forgo other pleasures and other invitations in order to protect the people they’ve made this alliance with,” she said. But Cannuscio noted that pods need to be ready to deal with members who can’t adhere perfectly to the rules, which is likely given that most people must have outside social contact as they go about their daily lives. “Rather than thinking of it as breaking the rules, I hope that it’s just considered a normal life event that has to be discussed with all the other members of the pod,” she said. “It’s not like that person was bad.” It is also important for pods to have a plan in the event that a member tests positive for the coronavirus or has a concerning exposure. O’Horo added that pod members should not hesitate to cancel plans and self-isolate if they aren’t feeling well. Because there are so many scenarios a pod must be prepared to handle, some experts recommend creating a written document that details the rules and the group’s responses to certain situations. “Anytime you’re verbalizing concepts or principles or rules, it’s easy to agree upon them in a discussion, but then when circumstances arise that deviate from the stated rules or appear to deviate from the stated rules, that becomes really messy in working it out with the other pod mates,” said Clarence Lam, director of the preventive medicine residency program at the Johns Hopkins Bloomberg School of Public Health. “To avoid some of those sticky circumstances with pod mates that may have a different understanding of what those rules are, I think it would be wise to write those rules down,” Lam added.

Be willing to change course While planning is essential to the success of a pod, experts stressed the importance of adapting to the ever-changing environment created by the pandemic. A pod should constantly be communicating and updating its guidelines to best suit its members, Knight said. “What we thought the normal was in May is not necessarily what the normal is today,” he said. “As we continue to learn about the virus and experience this pandemic, recommendations may change … risk understanding may change, and so we have to be flexible.” Cannuscio suggested that pods set routine check-ins to assess whether the method is still working for a majority of members. For new pods, she recommended a group meeting after the first two weeks. “If it’s not working, bail out and quarantine and start over with another pod,” she said. If a pod is no longer the right strategy for you, Cannuscio said, there are plenty of other ways to meet the need for social interaction. With creativity, she said, “people will find ways to

www.cbrne-terrorism-newsletter.com 195 HZS C2BRNE DIARY – October 2020 connect. They may look very different from our usual ways of socializing, but they will surely sustain us.”

Thermo Fisher Scientific Introduces New COVID-19 Antibody Tests

Oct 14 – Thermo Fisher Scientific Inc has introduced two new SARS-CoV-2 antibody tests: the Thermo Scientific OmniPATH COVID-19 Total Antibody ELISA test (under review by FDA), and the Thermo Scientific EliA SARS-CoV-2- Sp1 IgG test (commercially available). Keep Reading

Research Finds Risk of Catching COVID-19 on a Flight Akin to Being Struck by Lightning Source: https://www.iata.org/en/pressroom/pr/2020-09-08-012/

Oct 10 – The International Air Transport Association (IATA) has demonstrated the low incidence of inflight COVID-19 transmission with an updated tally of published cases. Since the start of 2020 there have been 44 cases of COVID-19 reported in which transmission is thought to have been associated with a flight journey (inclusive of confirmed, probable and potential cases). Over the same period some 1.2 billion passengers have traveled. “The risk of a passenger contracting COVID-19 while onboard appears very low. With only 44 identified potential cases of flight-related transmission among 1.2 billion travelers, that’s one case for every 27 million travelers. We recognize that this may be an underestimate but even if 90% of the cases were un- reported, it would be one case for every 2.7 million travelers. We think these figures are extremely reassuring. Furthermore, the vast majority of published cases occurred before the wearing of face coverings inflight became widespread,” said Dr. David Powell, IATA’s Medical Advisor. New insight into why the numbers are so low has come from the joint publication by Airbus, Boeing and Embraer of separate computational fluid dynamics (CFD) research conducted by each manufacturer in their aircraft. While methodologies differed slightly, each detailed simulation confirmed that aircraft airflow systems do control the movement of particles in the cabin, limiting the spread of viruses. Data from the simulations yielded similar results. Aircraft airflow systems, High Efficiency Particulate Air (HEPA) filters, the natural barrier of the seatback, the downward flow of air, and high rates of air exchange were all found to reduce the risk of disease transmission on board in normal times. The addition of mask-wearing amid pandemic concerns adds a further and significant extra layer of protection,

www.cbrne-terrorism-newsletter.com 196 HZS C2BRNE DIARY – October 2020 which makes being seated in close proximity in an aircraft cabin safer than most other indoor environments. IATA’s data collection, and the results of the separate simulations, align with the low numbers reported in a recently published peer- reviewed study by Freedman and Wilder-Smith in the Journal of Travel Medicine. Although there is no way to establish an exact tally of possible flight-associated cases, IATA’s outreach to airlines and public health authorities combined with a thorough review of available literature has not yielded any indication that onboard transmission is in any way common or widespread. Further, the Freedman/Wilder-Smith study points to the efficacy of mask-wearing in further reducing risk. Mask-wearing on board was recommended by IATA in June and is a common requirement on most airlines since the subsequent publication and implementation of the Takeoff Guidance by the International Civil Aviation Organization (ICAO). Aircraft design characteristics add a further layer of protection contributing to the low incidence of inflight transmission. The interaction of those design factors in creating a low-risk environment had been intuitively understood but not previously modeled prior to the CFD simulations by the three major manufacturers in each of their aircraft cabins. Airbus used CFD to create an accurate simulation of the air in an A320 cabin, to see how droplets resulting from a cough move within the cabin airflow. The simulation calculated parameters such as air speed, direction and temperature at 50 million points in the cabin, up to 1,000 times per second. Airbus then used the same tools to model a non-aircraft environment, with several individuals keeping six feet (1.8 meters) distance between them. The result was that potential exposure was lower when seated side by side on a plane than when staying six feet apart in an environment such as an office, classroom or grocery store. “After multiple, highly-detailed simulations using the most accurate scientific methods available, we have concrete data which reveals the aircraft cabin offers a much safer environment than indoor public spaces,” said Bruno Fargeon, Airbus Engineering and the leader of the Airbus Keep Trust in Air Travel Initiative. “The way that air circulates, is filtered and replaced on airplanes creates an absolutely unique environment in which you have just as much protection being seated side-by-side as you would standing six feet apart on the ground.” Using CFD, Boeing researchers tracked how particles from coughing and breathing move around the airplane cabin. Various scenarios were studied including the coughing passenger with and without a mask, the coughing passenger located in various seats including the middle seat, and different variations of passengers’ individual overhead air vents (known as gaspers) on and off. “This modeling determined the number of cough particles that entered the breathing space of the other passengers”, said Dan Freeman, the chief engineer for Boeing’s Confident Travel Initiative. “We then compared a similar scenario in other environments, such as an office conference room. Based on the airborne particle count, passengers sitting next to one another on an airplane is the same as standing more than seven feet (or two meters) apart in a typical building environment.” Using CFD, cabin air flow and droplet dispersion models validated in full-scale cabin environment testing, Embraer analyzed the cabin environment considering a coughing passenger in several different seats and air flow conditions in our different aircraft to measure these variables and their effect. The research Embraer completed shows that risk of onboard transmission is extremely low, and the actual data on in-flight transmissions that may have occurred, supports these findings. Luis Carlos Affonso, Senior Vice-President of Engineering, Technology and Strategy, Embraer, said, “The human need to travel, to connect, and to see our loved ones has not disappeared. In fact, at times like this, we need our families and friends even more. Our message today is that because of the technology and procedures in place, you can fly safely – all the research demonstrates this. In fact, the cabin of a commercial aircraft is one of the safer spaces available anywhere during this pandemic.” A recent IATA study found that 86% of recent travelers felt that the industry’s COVID-19 measures were keeping them safe and were well-implemented. “There is no single silver-bullet measure that will enable us to live and travel safely in the age of COVID-19. But the combination of measures that are being put in place is reassuring travelers the world over that COVID-19 has not defeated their freedom to fly. Nothing is completely risk-free. But with just 44 published cases of potential inflight COVID-19 transmission among 1.2 billion travelers, the risk of contracting the virus on board appears to be in the same category as being struck by lightning,” said Alexandre de Juniac, IATA’s Director General and CEO.

• View the IATA Presentation (pdf) • View the Airbus Presentation (pdf) • View the Boeing Presentation (pdf) • View the Embraer Presentation (pdf) • View the full Media Briefing (YouTube)

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Covid-Sniffing Robots Offer Testing Alternative Source: https://www.bloomberg.com/news/articles/2020-10-01/covid-sniffing-robots-offer-a-testing-alternative-startup-bets

Oct 01 – A biotechnology startup called Koniku is trying to develop robots that could sniff out Covid-19 infections faster than conventional testing. The technology fuses neurons with a silicon chip to create a “smell cyborg” capable of detecting scents ranging from explosives to pathogens. Koniku’s first clinical trial began three weeks ago and will examine samples from patients tested for Covid-19 to compare how well the smell-bot detects the virus compared with traditional methods. Small internal trials have already demonstrated that it can accurately detect the presence of influenza A. “Our goal is to have a device that merges synthetic biology with silicon and maps all of the smells of human life on a global scale,” said Oshiorenoya Agabi, the San Rafael, California-based company’s chief executive officer and co-founder. “We should have a device in every home in America to screen for disease.” Pathogens produce unique volatile organic compounds, scent-fingerprints of a sort, released by ailing cells. These signature smells are the same biological clues that allow dogs to sniff out dozens of diseases. Finland tested the ability of dogs to detect Covid-19 in a trial at Helsinki’s airport last month. Some researchers have suggested that using dogs could be cheaper, faster and even potentially more effective in screening for the disease than methods including temperature checks, nasal swabs and saliva. In July, German researchers showed trained dogs were able to distinguish between saliva sampled from people infected with the virus and those who were not more than 90 percent of the time.

Koniku’s device, the Konikore, is slightly smaller than a frisbee and resembles a flying saucer. When the proteins in its chip bind to a scent it has been programmed to detect, cells amplify and process those signals with help from machine learning, and the device lights up. In a recent field test in Alabama, it was able to detect explosives better than trained dogs. The test was conducted by law-enforcement officials and aerospace giant Airbus SE, a Koniku investor and partner that has been working to roll out the technology in airports.

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Koniku plans to conduct field trials with Airbus at Changi Airport in Singapore and then San Francisco International Airport later this year.

Smell Camera “If a dog can smell it, we can,” said Agabi, who describes the Konikore as a “smell camera.” He imagines the technology could be useful far beyond bombs and diseases. For example, he said, it could digitize the taste of food, allowing for the synthetic recreation of things like bacon. Koniku’s merger of biology and computing technology — often termed “wetware” — is a growing field. The company’s investors include SoftBank, Platform Capital, Halfcourt Ventures, Changi Airport and Airbus’s venture-capital arm. Koniku has hired Treximo, a biotech consulting and project management company, to conduct its trials for SARS-CoV-2. Trials for new devices are typically far faster and less intensive than those for new drugs. Treximo said it expects it will be done with the necessary steps to apply for an emergency-use authorization with the Food and Drug Administration in the first quarter of 2021. “We know this device can smell explosives, but can we have it pick up organic compounds in human breath to say yes or no does this person have SARS-CoV-2?” said Treximo CEO Michael Stomberg. “It’s a game-changing device if it proves to be valid.” The devices will go on pre-sale for hardware developers this week. After Covid-19, Agabi imagines the company pursuing other diseases insurance companies might be inclined to cover the cost of a test for, such as lung cancer. In the future, if successful, it could be used not just in homes, but for mass detection of diseases and pathogens in public spaces. “Telehealth is growing,” said Agabi. “Our goal is not another Zoom application, but to actually bring technology closer to people to be able to screen disease in real time.”

COVID-19 linked to sudden hearing loss Source: https://www.livescience.com/covid-19-linked-to-sudden-hearing-loss.html

Oct 14 – A man in the U.K. developed sudden and permanent hearing loss in one ear after battling a severe case of COVID-19, according to a new report. His doctors are now warning others to be on the lookout for this rare but serious complication, which has been reported in a handful of COVID-19 patients around the world. Early identification of sudden hearing loss is important because the condition can potentially be reversed with prompt treatment using steroids, the authors said. However, for the U.K. patient, treatment only partially improved his hearing, the report said. Sudden hearing loss, also known as sudden deafness, is rapid and unexplained hearing loss that happens instantly or over the course of a few days, and typically affects only one ear, according to the National Institute on Deafness and Other Communication Disorders. The condition is not uncommon; there are as many as 160 cases per 100,000 in a population each year, the authors said. In most cases, doctors aren't able to identify a cause of sudden hearing loss, but the condition has been linked with viral infections, including infections with the flu, herpes and cytomegalovirus. In the new report, published Tuesday (Oct. 13) in the journal BMJ Case Reports, the authors describe the case of a 45-year-old man with asthma who developed sudden hearing loss while being treated for COVID-19. The man had been admitted to the hospital's intensive care unit (ICU) after experiencing difficulty breathing. He was placed on a ventilator for 30 days and received treatment with the antiviral drug remdesivir. Eventually, the man began to improve, and he left the ICU. But a week later, he noticed tinnitus, or ringing, in his left ear, followed by sudden hearing loss in that ear, the report said. The man had not experienced hearing problems before, and he was healthy prior to his diagnosis. After undergoing a physical exam and MRI, doctors couldn't find a cause of his hearing loss, such as a blockage or inflammation. He also tested negative for other potential causes of hearing loss, including rheumatoid arthritis, flu and HIV, leading his doctors to hypothesize that the patient's hearing loss was related to COVID-19.

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The man was treated with steroids, the standard treatment for sudden hearing loss, which partially improved his hearing, but did not restore it to normal. The patient noted that it was difficult for him to recognize his hearing loss in the busy ICU, and so his hearing loss may have developed earlier than he realized. His doctors reviewed the medical literature and found five other reports of cases of COVID-19 tied to sudden hearing loss, including reports in Egypt, Turkey and Germany. The new case is the first reported in the U.K., the authors said. The authors found only an association and can’t prove that SARS-CoV-2, the virus that causes COVID-19, directly causes hearing loss. But they note that cells lining the middle ear have been found to have ACE-2 receptors, which SARS-CoV-2 uses to get inside cells. In addition, the infection can increase levels of inflammatory chemicals in the body that have been linked with hearing loss, they said. The authors call for further investigation into the link between COVID-19 and sudden hearing loss, "given the widespread presence of the virus in the population and the significant morbidity of hearing loss." They recommend asking COVID-19 patients in the ICU about hearing loss, and urgently referring any patients with these symptoms to an ear, nose and throat doctor.

Top 10 Covid-19 vaccines in development At least 44 vaccines are being tested in clinical trials on humans around the world

Source: https://www.thenationalnews.com/uae/science/who-are-the-10-frontrunners-in-the-hunt-for-a- covid-vaccine-1.1093875

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How a Bizarre Claim About Masks Has Lived on for Months By Olga Khazan Source: https://www.theatlantic.com/politics/archive/2020/10/can-masks-make-you-sicker/616641/

Oct 09 – When I first waded into the latest mask conspiracy theory, I was literally wading. About a month ago, I was in my local pool when I overheard a middle-aged woman in the next lane whisper it to her friend, in the way you vaguely assert something that you’re pretty sure is true but don’t fully understand. “Masks don’t even do anything,” she said. “In fact, they can make you sicker. Because you’re breathing in all the ... stuff ... you breathe out.” “OK Boomer,” I thought. I dismissed her as a random neighborhood conspiracist and swam my laps. But then I started to see this false notion appear more frequently on Facebook. It wasn’t the typical argument anti-maskers use, that mask mandates infringe on people’s freedoms. It was that the masks themselves are causing illness. The horror of the idea was apparent even to me: the feds, in their hall-monitor stupidity, forcing you to do something that’s actually bad for you. Most recently, this surfaced in the form of “copypasta”—a post copied and pasted by many people onto social media, rather than shared as a link—from a purported “OSHA Inspector.” “I have worked in a clean room for 23 years and 10 years on submarines before that,” it reads. The inspector, supposedly from the Occupational Safety and Health Administration, goes on to debunk each type of mask. N95s won’t “filter your air on the way out,” so they don’t reduce the risk of catching COVID-19 from someone who has it. Surgical masks, the post claims, are rendered useless by the moisture from your breath and the “number of particles” on them. Cloth masks, meanwhile, trap carbon dioxide, risking the health of the wearer. “I know, facts suck,” it concludes. “They throw a wrench into the perfectly (seeming) packaged pill you are willingly swallowing.”

Trump’s Gold-Plated Health Care Aside from the fact that few bureaucrats speak this plainly and concisely, there are a number of obvious signs that this information is false. Every kind of face mask has been proved, in study after study, to slow the spread of COVID-19, with N95s being the most effective. To name just one example, two stylists worked at a hair salon in Missouri while infected with the coronavirus, but none of the 139 clients they saw got sick, because everyone wore a mask. Mainstream experts dismiss the idea that wearing a mask can make you sick, unless you never wash the mask or have a health condition that makes breathing difficult. “The way that masks are being recommended is perfectly safe,” says Angela Rasmussen, a virologist at Columbia University. Cloth masks don’t offer complete protection against the coronavirus, she says, but they reduce the risk enough that they’re worth wearing whenever you’re going to be around people. Though the latest public posts mentioning the supposed OSHA inspector date from September, the idea that masks make you sicker has been spreading online for months now, even after various fact-checking sites debunked the claim. I emailed Facebook to ask for more information about this type of post, but the company did not respond. One instance of the OSHA post was taken down after my email. But others live on, circulating among mask-haters and affirming what they perceive to be their righteousness. The post is an especially bizarre example of the “infodemic” scientists have been battling alongside the coronavirus pandemic, in which the internet is a giant telephone game reverberating with the weirdest stuff imaginable. In late July, the “masks make you sick” claim was already circulating in prominent conservative circles. In a video, the conservative activist Charlie Kirk said, “Some doctors think that masks actually make you sicker and have you less likely to be able to get oxygen.” (I reached out to Kirk on Twitter, but he did not respond.) The OSHA connection also came up in an anti-mask video made by a conservative chiropractor with 3,000 Facebook followers. But the previous month, the OSHA claim had already been widely debunked. Snopes wrote an article on June 18 refuting a near- identical version of the Facebook post that was still bouncing around in September. Not only does the post have its science wrong— people wearing cloth masks are in no danger of breathing in too much carbon dioxide—but it also refers to an OSHA certification that does not exist. “The author of the Facebook post claimed to be ‘OSHA 10&30 certified,’” the Snopes article says. “We reached out to OSHA, and a representative told us that these courses ‘do not include COVID-19 topics,’ nor does OSHA ‘certify’ trainers.”

The Most American COVID-19 Failure Yet It’s not clear how OSHA got roped into this. Part of the Department of Labor, the agency primarily concerns itself with safe working conditions, rather than pandemic responses. People who don’t want to do something, like wear masks, will often glom onto quasi-scientific rationalizations, says Matt Motta, a political scientist at Oklahoma State University who studies online misinformation.

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Outside of Facebook, a June 18 article on a site called GreenMedInfo claims that “OSHA says masks don’t work—and violate OSHA oxygen levels.” The article consists mainly of a video by Peggy Hall, the founder of an anti-mask site called thehealthyamerican.org, explaining how “the U.S. Department of Labor Occupational and Safety and Health Administration’s guidelines clearly show cloth and surgical masks don’t work to reduce transmission of COVID-19, and how they deplete the body of oxygen, causing adverse health effects.” (In response to a request for comment, an OSHA spokesperson told me that this is not true, and that masks do not compromise oxygen levels or cause carbon dioxide buildup.) The video is no longer available, and when I emailed Hall, she said it had been taken down. “My now-banned videos simply explained that OSHA, the FDA and the CDC all have no evidence of masks preventing the spread of this virus,” Hall wrote. (They do.) “Since they are making the claim, the burden of proof is on those agencies to show that the masks DON’T make anyone sick.” This is, of course, a completely different statement than the one made in the article. And indeed, a few days later, the fact-checking site debunked Hall’s article, too. Before that, anti-mask articles and advocates would occasionally claim that masks made people sick, but they rarely invoked OSHA. A Chattanooga, Tennessee, news station in early June claimed, “Wearing a fabric mask for long periods of time—or for several days at a time—can allow bacteria to build up and actually make you sick,” but didn’t cite any research or experts to back the claim. In May, a group of filmmakers released a video titled , which traveled widely on social media. It featured the discredited researcher Judy Mikovits saying, among other things, that masks can make people sick. was viewed millions of times before Facebook and YouTube removed it. (Mikovits did not respond to a request for comment.) These videos and articles all came months after government officials had begun encouraging—and then mandating—that people wear masks in public. But crucial to understanding the spread of this particular piece of misinformation is that, for many weeks early in the pandemic, everyday people were told not to wear masks. Back then, prominent experts claimed masks were needed for health- care workers and were borderline ineffective for the general public. Versions of this advice also suggested that masks could raise the risk of illness. On March 12, Jenny Harries, England’s deputy chief medical officer, claimed that masks could “actually trap the virus.” Therefore, she said, “for the average member of the public walking down a street, it is not a good idea.” (Harries did not respond to a request for comment.) In fact, the earliest instance of a “masks make you sicker” claim I could find was in a February 27 news article published on a Utah radio station’s website. (Its author did not return a request for comment.) Though the article has since been updated, the original contains the subhead “Wearing a face mask incorrectly might put you at greater risk of getting sick.” The article then quotes a doctor named David Eisenman as saying, “I think people see a mask and they see an illusion of protection.” Though Eisenman’s quote does not quite support the subheading on the article, I reached out to him to see whether he still stands by his interview. In short, he does not. “These things come back and haunt you,” Eisenman, a professor-in-residence at UCLA, told me. “Science recommendations have evolved. Now I would say that the evidence is very much in favor of masks as an important protector in the spread of COVID-19.” Eisenman says the article was widely read. People occasionally tweet at him asking how he can be recommending masks now when he didn’t six months ago. He explains that the science changed, and so did his advice, but according to him, “it doesn’t seem to satisfy anybody.” The “masks make you sicker” idea underscores how online misinformation is like an ocean liner: Once it’s headed in one direction, it’s difficult to turn around. The advice on masks changed seven months ago, but some people have stuck with what experts were saying in the confusing early days. One doctor’s criticisms of masks—which he now recants—live on in Twitter threads. And as people find new ways to share incorrect information, through posts, photos, and videos, social-media platforms are struggling to catch and remove all the hokum. Before long, the conspiracy theories break free of Facebook and infect reality.

Olga Khazan is a staff writer at and the author of Weird: The Power of Being an Outsider in an Insider World.

Long Covid could be four syndromes affecting the body at the same time, report finds Source: https://www.thenationalnews.com/uae/health/coronavirus-long-covid-could-be-four-syndromes-affecting-the-body-at-the- same-time-report-finds-1.1094187

Oct 15 – A new report adds to research that months later patients experience a recurring mixture of symptoms

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New research indicates that ‘long Covid’ could be a debilitating mixture of four syndromes attacking the body at the same time. A study by the UK’s National Institute for Health Research warns of the crippling psychological and physical impact on people living with the long-term consequences of the coronavirus. Long Covid is the term used to describe a growing number of people who may have initially suffered mild illness, only to struggle with the lingering effects of Covid-19 for months after they seemingly recovered from the virus. Based on interviews with 14 members of a long Covid support group on Facebook, the study found a “rollercoaster of symptoms.” The symptoms cover every part of the body and brain Researchers said this may be due to four syndromes, those being permanent organ damage to the lungs and heart, experience of post-viral fatigue, post intensive care syndrome and a continuation of Covid-19 symptoms. Patients studied described it as a ‘Covid tunnel’ even seven months later and appealed for support. Themes that emerged from the discussion were that patients were often doubted and not treated. Elaine Maxwell, author of the review, said some patients experienced "floating symptoms" that moved around the body. "The list of symptoms is huge and covers every part of the body and brain,” she said. "People without a clear diagnosis told us they are often not believed by health services.” Months after recovering from the virus, patients detailed brain fog and chronic fatigue that affected their heart, breathing, kidneys, gut, liver and skin. Ms Maxwell said it was wrong to assume that those critically ill with Covid-19 would be the worst affected. "There are people who never had any support in hospital, never had a test, have no record of ever having had Covid except their own personal history. They may be suffering far more than somebody who is ventilated for 21 days,” she said. An opera singer, Lee, said he was unwell with cough, fever and cold in February due to Covid-19. Weeks later he suffered exhaustion, spoke of strange taste and brain fog. From walking more than six miles daily, he struggled to walk to the end of a street. The power and quality of his singing remained but he could not keep up with conversations and online meetings. “Slowly, after nearly six months I am slowly beginning to see more ‘normal’ days but as soon as I begin to feel better, the cycle starts again,” he said. The report said thousands could be living with long Covid, with children also at risk. Other research has uncovered the threat from long Covid. A study published in Italy showed nine in ten patients who required hospital care had experienced after-effects two months on.

Coronavirus outbreak Another study in France adds to evidence that a portion of the 38 million people infected with the Sars-CoV-2 virus worldwide will suffer lingering effects. The UK report calls for support from the community and healthcare centres. It said the disease would likely have a disproportionate effect on groups such as black, Asians, people with mental health problems or learning difficulties. “We hope this review will be useful to the public, health and social care professionals, researchers, service providers and policy makers and lead to better understanding of the issues around living with Covid19," the report said. Researchers took the decision to release findings despite the small amount of published evidence due to the importance of the subject and the need for people to receive care. Last month, The National spoke to a number of UAE residents battling the ill-effects of long Covid, who described a variety of symptoms, from bouts of dizziness and chronic headaches to pain in the chest and joints.

We Just Got More Evidence Your Blood Type May Change COVID-19 Risk and Severity Source: https://www.sciencealert.com/study-gives-more-evidence-that-blood-type-may-change-covid-19-risk-and-severity

Oct 15 – Research is coalescing around the idea that people with Type O blood may have a slight advantage during this pandemic. Two studies published this week suggest that people with Type O have a lower risk of getting the coronavirus, as well as a reduced likelihood of getting severely sick if they do get infected.

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One of the new studies specifically found that COVID-19 patients with Type O or B blood spent less time in an intensive-care unit than their counterparts with Type A or AB. They were also less likely to require ventilation and less likely to experience kidney failure. These new findings echo similar findings about Type O blood seen in previous research, creating a clearer picture of one particular coronavirus risk factor.

Patients with Type O or B blood had less severe COVID-19 Both new studies came out Wednesday in the journal Blood Advances. One looked at 95 critically ill COVID-19 patients at hospitals in Vancouver, Canada, between February and April. They found that patients with Type O or B blood spent, on average, 4.5 fewer days in the intensive-care unit than those with Type A or AB blood. The latter group stayed, on average, 13.5 days in the ICU. The researchers did not see any link between blood type and the length of each patient's total hospital stay, however. They did, however, find that only 61 percent of the patients with Type O or B blood required a ventilator, compared to 84 percent of patients with Type A or AB. Patients with Type A or AB, meanwhile, were also more likely to need dialysis, a procedure that helps the kidneys filter toxins from the blood. "Patients in these two blood groups may have an increased risk of organ dysfunction or failure due to COVID-19 than people with blood types O or B," the study authors concluded. A June study found a similar link: Patients in Italy and Spain with Type O blood had a 50 percent reduced risk of severe coronavirus infection (meaning they needed intubation or supplemental oxygen) compared to patients with other blood types.

People with Type O blood had 'reduced susceptibility' to infection The second new study found that people with Type O blood may be at a lower risk of getting he coronavirus in the first place relative to people with other blood types. The team examined nearly half a million people in the Netherlands who were tested for COVID-19 between late February and late July. Of the roughly 4,600 people who tested positive and reported their blood type, 38.4 percent had Type O blood. That's lower than the prevalence of Type O in a population of 2.2 million Danish people, 41.7 percent, so the researchers determined that people with Type O blood had disproportionately avoided infection. "Blood group O is significantly associated with reduced susceptibility," the authors wrote.

Other studies found a similar link between blood type and COVID-19 risk In general, your blood type depends on the presence or absence of proteins called A and B antigens on the surface of red blood cells - a genetic trait inherited from your parents. People with O blood have neither antigen. It's the most common blood type: About 48 percent of Americans have Type O blood, according to the Oklahoma Blood Institute. The new studies about blood type and coronavirus risk align with prior research on the topic. A study published in July found that people with Type O were less likely to test positive for COVID-19 than those with other blood types. An April study, too, (though it has yet to be peer-reviewed) found that among 1,559 coronavirus patients in New York City, a lower proportion than would be expected had Type O blood. And in March, a study of more than 2,100 coronavirus patients in the Chinese cities of Wuhan and Shenzhen also found that people with Type O blood had a lower risk of infection. Past research has also suggested that people with Type O blood were less susceptible to SARS, which shares 80 percent of its genetic code with the new coronavirus. A 2005 study in Hong Kong found that most individuals infected with SARS had non-O blood types. Despite this growing body of evidence, however, Mypinder Sekhon, a co-author of the Vancouver study, said the link is still tenuous. "I don't think this supersedes other risk factors of severity like age and comorbidities and so forth," he told CNN, adding, "if one is blood group A, you don't need to start panicking. And if you're blood group O, you're not free to go to the pubs and bars."

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Multiple Coronaviruses, Same Drug Targets Source: https://www.genengnews.com/news/multiple-coronaviruses-same-drug-targets/

Oct 15 – One drug to inhibit them all—all coronaviruses, that is, or at least the three evaluated in a recent study, namely, SARS- CoV-2, SARS-CoV-1, and MERS-CoV. According to the study, these deadly coronaviruses hijack the same host pathways. Consequently, all these coronaviruses could be targeted by the same antiviral drugs. The trick is to find drugs that interfere with crucial, highly conserved virus-host protein interactions. Such interactions were mapped by an international team of almost 200 researchers, including researchers from over a dozen academic institutions and four companies (Aetion, a developer of analytics software; Synthego, a genome engineering company; Beam Therapeutics, a company that develops genetic medicines through the use of base editing; and HeathVerity, a company that links and de-identifies patient data). The study’s lead investigator was Nevan Krogan, PhD, director of the Quantitative Biosciences Institute (QBI) at the School of Pharmacy at the University of California, San Francisco. “In unique and rapid fashion, we were able to bridge biological and functional insights with clinical outcomes,” said Krogan, who is also a senior investigator at Gladstone Institutes. Krogan and colleagues presented their findings October 15 in Science, in an article titled, “Comparative host-coronavirus protein interaction networks reveal pan-viral disease mechanisms.” The article describes how the scientists used proteomics, cell biology, virology, genetics, structural biology, biochemistry, and clinical and genomic information to provide a holistic view of SARS-CoV-2 and other coronaviruses’ interactions with infected host cells. “[We] carried out comparative viral-human protein-protein interaction and viral protein localization analysis for all three viruses,” wrote the article’s authors. “Subsequent functional genetic screening identified host factors that functionally impinge on coronavirus proliferation, including Tom70, a mitochondrial chaperone protein that interacts with both SARS-CoV-1 and SARS-CoV-2 Orf9b, an interaction we structurally characterized using cryo-EM.” In addition, using the molecular insights gained from this multidisciplinary, systematic study of coronaviruses, the scientists performed an analysis of medical records of approximately 740,000 patients with documented SARS-CoV-2 infection. In this analysis, the scientists were especially interested in identifying “important molecular mechanisms and potential drug treatments that merit further molecular and clinical study.” Prior studies had identified more than 300 host cell proteins that can interact with SARS-CoV-2 proteins. In the current study, the investigators extended this work to SARS-CoV-1 and MERS-CoV. Interestingly, the team found that the mitochondrial outer membrane protein Tom70 interacts with both SARS-CoV-1 and SARS- CoV-2 protein Orf9b. Tom70 is normally involved in the activation of mitochondrial antiviral-signaling protein (MAVS) and is essential for an antiviral innate immune response. Orf9b, by binding to the substrate recognition site of Tom70, inhibits Tom70’s interaction with heat shock protein 90 (Hsp90), which is key for its function in the interferon pathway and induction of apoptosis upon virus infection. In a collaboration among more than 60 scientists in the QCRG led by Klim Verba and Oren Rosenberg at QBI, the structure of Orf9b bound to the active site of Tom70 was determined by cryoelectron microscopy (cryoEM) to a remarkable three-angstrom resolution. A noteworthy and rare finding showed that Orf9b, when by itself, forms a dimer and structurally a beta sheet, but exists as an alpha helix when bound to Tom70. Using the structural image of the bound proteins, the scientists were able to discover that a key residue in the interaction with Hsp90 is moved out of position, suggesting that Orf9b may modulate key aspects of the immune response, interferon, and apoptosis signaling via Tom70. The functional significance and regulation of the Orf9b-Tom70 interaction require further experimental elucidation. This interaction, however, which is conserved between SARS-CoV-1 and SARS-CoV-2, could have value as a pan- coronavirus therapeutic target. Using the three coronavirus interactomes as a guide, the team performed CRISPR and RNA interference (RNAi) knockouts of the putative host proteins of each virus and studied how loss of these proteins altered the ability of SARS-CoV-2 to infect human cells. They determined that 73 of the proteins studied were important for the replication of the virus and used this list to prioritize evaluation of drug candidates. Among these were the receptor for the inflammatory signaling molecule IL-17, which has been identified in numerous studies as an important indicator of disease severity; prostaglandin E synthase 2 (encoded by PTGES2), which functionally interacts with the Nsp7 protein in all three viruses; and sigma receptor 1, an interactor of Nsp6 from SARS-CoV-1 and SARS-CoV-2, which the group previously showed was a promising drug target in the laboratory setting.

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It was at this point that the team analyzed the medical billing data from the approximately 740,000 people who tested positive for SARS-CoV-2 or were presumptively positive. In the outpatient setting, SARS-CoV-2-positive, new users of indomethacin, a non- steroidal anti-inflammatory drug (NSAID) that targets PGES-2, were less likely than matched new users of celecoxib, an NSAID that does not target PGES-2, to require hospitalization or inpatient services. In the inpatient setting, again leveraging the medical billing data, the group compared the effectiveness of typical antipsychotics, namely haloperidol, which have activity against sigma receptor 1, versus atypical antipsychotics, which do not. Half as many new users of typical antipsychotics compared to new users of atypical antipsychotics progressed to the point of requiring mechanical ventilation. Typical antipsychotics can have significant adverse effects, but other sigma receptor 1-targeting drugs exist and more still are in development. “It is critical to note that the number of patients taking each of these compounds represent small, non-interventional studies,” commented Krogan. “They are nonetheless powerful examples of how molecular insight can rapidly generate clinical hypotheses and help prioritize candidates for prospective clinical trials or future drug development. A careful analysis of the relative benefits and risks of these therapeutics should be undertaken before considering prospective studies or interventions.” “These analyses demonstrate how biological and molecular information are translated into real-world implications for the treatment of COVID-19 and other viral diseases,” said Pedro Beltrao, PhD, a corresponding author of the study and group leader at EMBL’s European Bioinformatics Institute. “After more than a century of relatively harmless coronaviruses, in the last 20 years we have had three coronaviruses which have been deadly. By looking across the species, we have the capability to predict pan-coronavirus therapeutics that may be effective in treating the current pandemic, which we believe will also offer therapeutic promise for a future coronavirus as well.”

This blood test may predict which hospitalized COVID-19 patients are at risk for severe illness Source: https://www.yahoo.com/lifestyle/this-blood-test-may-predict-which-covid-19-patients-are-at-risk-for-severe-illness-233553450.html

Oct 16 – Scientists have developed a blood test and new scoring system that may help doctors predict which COVID-19 patients are at risk for severe disease and therefore in need of more intervention, according to a new study published in the journal EBioMedicine. In the study, scientists performed blood tests on 80 patients hospitalized for COVID-19 and then measured the patients’ levels of two different cytokines — IL-6 and IL-10 — which act as messengers for the immune system. The study’s senior author, Gerry McElvaney, a professor of medicine at RCSI University of Medicine and Health Sciences in Ireland, tells Yahoo Life that IL-6 is a “pro-inflammatory protein,” while IL-10 is an “anti-inflammatory protein” and that both are “known to be altered in COVID-19” patients. “IL-6 is kind of turning on the immune system, while IL-10 is one of our anti-inflammatory cytokines that tries to turn things down,” Dr. Matt Exline, a pulmonary and critical care specialist at the Ohio State University Wexner Medical Center, tells Yahoo Life. “As you’re fighting an infection, the body is trying to find an even keel” between the two. “If it’s too turned up, that’s bad,” says Exline, “and if it’s too turned down that’s also bad. I think the concept they identified [in the study] is an important one.” The scientists noted in the study that, based on their own previous research, “pro-inflammatory cytokines,” in particular IL-6, “were increased in those with severe illness.” So, having a blood test that could show a “loss of balance between pro-inflammatory and anti-inflammatory mediators in COVID-19” could signal that a patient is at a greater risk of developing a severe infection. To rate any changes in the balance of IL-6 and IL-10, the researchers came up with a five-point linear scoring system designed to predict clinical outcomes, called the Dublin-Boston score. According to the researchers, every one-point increase in the score was associated with a 5.6 times higher risk of a more severe outcome. According to EurekAlert: “The Dublin-Boston score can now accurately predict how severe the infection will be on day seven after measuring the patient's blood for the first four days.” McElvaney told EurekAlert that a “more informed prognosis could help determine when to escalate or de-escalate care,” helping hospitals use resources more efficiently, adding: “The score may also have a role in evaluating whether new therapies designed to decrease inflammation in COVID-19 actually provide benefit." He tells Yahoo Life that the scoring system is “easy to calculate and easy for clinicians to interpret. The limiting factor is that, although many hospitals and laboratories worldwide are testing for IL-6, IL-10 is less widely tested. As awareness of IL-10 grows, more hospitals and laboratories have begun to look at it, however.”

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McElvaney says that he and his team “hope... that the Dublin-Boston score will help guide clinical decision-making, help identify patients who might benefit from novel therapies, and provide an objective means of measuring the response to these therapies.” While Exline and Dr. Dean Winslow, an infectious disease specialist at Stanford Health Care, both tell Yahoo Life that the study results are “interesting,” they agree that more research is needed. “The utility of this IL-6 to IL-10 ratio would probably need to be validated in larger studies,” says Winslow, adding that researchers would have to “couple the prognostic information we get from looking at this IL-6 and IL-10 ratio… with therapeutic interventions to see how really useful it is” in helping COVID-19 patients in clinical settings. But Exline adds that “most labs in many hospitals have these [blood tests] readily available, so if it works out [with further research], it would be something we could put into practice quickly.”

When Will the Pandemic End? If We Look at History, The Answer Is Not So Simple By Nükhet Varlik Source: https://www.sciencealert.com/history-tells-us-the-future-of-the-coronavirus-pandemic-has-no-end-date

Oct 15 – When will the pandemic end? All these months in, with over 37 million COVID-19 cases and more than 1 million deaths globally, you may be wondering, with increasing exasperation, how long this will continue. Since the beginning of the pandemic, epidemiologists and public health specialists have been using mathematical models to forecast the future in an effort to curb the spread of the coronavirus. But infectious disease modeling is tricky. Epidemiologists warn that "[m]odels are not crystal balls," and even sophisticated versions, like those that combine forecasts or use machine learning, can't necessarily reveal when the pandemic will end or how many people will die. As a historian who studies disease and public health, I suggest that instead of looking forward for clues, you can look back to see what brought past outbreaks to a close – or didn't.

Where we are now in the course of the pandemic In the early days of the pandemic, many people hoped the coronavirus would simply fade away. Some argued that it would disappear on its own with the summer heat. Others claimed that herd immunity would kick in once enough people had been infected. But none of that has happened. A combination of public health efforts to contain and mitigate the pandemic – from rigorous testing and contact tracing to social distancing and wearing masks – have been proven to help. Given that the virus has spread almost everywhere in the world, though, such measures alone can't bring the pandemic to an end. All eyes are now turned to vaccine development, which is being pursued at unprecedented speed.

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Yet experts tell us that even with a successful vaccine and effective treatment, COVID-19 may never go away. Even if the pandemic is curbed in one part of the world, it will likely continue in other places, causing infections elsewhere. And even if it is no longer an immediate pandemic-level threat, the coronavirus will likely become endemic – meaning slow, sustained transmission will persist. The coronavirus will continue to cause smaller outbreaks, much like seasonal flu. The history of pandemics is full of such frustrating examples.

Once they emerge, diseases rarely leave Whether bacterial, viral or parasitic, virtually every disease pathogen that has affected people over the last several thousand years is still with us, because it is nearly impossible to fully eradicate them. The only disease that has been eradicated through vaccination is smallpox. Mass vaccination campaigns led by the World Health Organization in the 1960s and 1970s were successful, and in 1980, smallpox was declared the first – and still, the only – human disease to be fully eradicated. So, success stories like smallpox are exceptional. It is rather the rule that diseases come to stay. Take, for example, pathogens like malaria. Transmitted via parasite, it's almost as old as humanity and still exacts a heavy disease burden today: There were about 228 million malaria cases and 405,000 deaths worldwide in 2018. Since 1955, global programs to eradicate malaria, assisted by the use of DDT and chloroquine, brought some success, but the disease is still endemic in many countries of the Global South. Similarly, diseases such as tuberculosis, leprosy and measles have been with us for several millennia. And despite all efforts, immediate eradication is still not in sight. Add to this mix relatively younger pathogens, such as HIV and Ebola virus, along with influenza and coronaviruses including SARS, MERS and SARS-CoV-2 that causes COVID-19, and the overall epidemiological picture becomes clear. Research on the global burden of disease finds that annual mortality caused by infectious diseases – most of which occurs in the developing world – is nearly one-third of all deaths globally. Today, in an age of global air travel, climate change and ecological disturbances, we are constantly exposed to the threat of emerging infectious diseases while continuing to suffer from much older diseases that remain alive and well. Once added to the repertoire of pathogens that affect human societies, most infectious diseases are here to stay.

Plague caused past pandemics – and still pops up Even infections that now have effective vaccines and treatments continue to take lives. Perhaps no disease can help illustrate this point better than plague, the single most deadly infectious disease in human history. Its name continues to be synonymous with horror even today. Plague is caused by the bacterium Yersinia pestis. There have been countless local outbreaks and at least three documented plague pandemics over the last 5,000 years, killing hundreds of millions of people. The most notorious of all pandemics was the Black Death of the mid-14th century. Yet the Black Death was far from being an isolated outburst. Plague returned every decade or even more frequently, each time hitting already weakened societies and taking its toll during at least six centuries. Even before the sanitary revolution of the 19th century, each outbreak gradually died down over the course of months and sometimes years as a result of changes in temperature, humidity and the availability of hosts, vectors and a sufficient number of susceptible individuals. Some societies recovered relatively quickly from their losses caused by the Black Death. Others never did. For example, medieval Egypt could not fully recover from the lingering effects of the pandemic, which particularly devastated its agricultural sector. The cumulative effects of declining populations became impossible to recoup. It led to the gradual decline of the Mamluk Sultanate and its conquest by the Ottomans within less than two centuries. That very same state-wrecking plague bacterium remains with us even today, a reminder of the very long persistence and resilience of pathogens. Hopefully COVID-19 will not persist for millennia. But until there's a successful vaccine, and likely even after, no one is safe. Politics here are crucial: When vaccination programs are weakened, infections can come roaring back. Just look at measles and polio, which resurge as soon as vaccination efforts falter. Given such historical and contemporary precedents, humanity can only hope that the coronavirus that causes COVID-19 will prove to be a tractable and eradicable pathogen. But the history of pandemics teaches us to expect otherwise.

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Nükhet Varlik is Associate Professor of History @ University of South Carolina.

ILC Therapeutics announces ‘significant’ COVID-19 drug breakthrough Source: https://www.pharmiweb.com/press-release/2020-10-07/ilc-therapeutics-announces-significant-covid-19-drug-breakthrough

Oct 07 – ILC Therapeutics, a Scottish biotech company, has announced that its unique synthetic Interferon called Alfacyte™ is fifteen to twenty times more effective at preventing the spread of SARS-CoV-2 (the virus which causes COVID-19) in cell culture than other commercially-available Interferons such as Interferon alpha 2 and Interferon beta 1a. COVID-19 tries to slow down the body’s innate Interferon response to viral infection and Alfacyte™ is designed to help accelerate this response and prevent disease progression. Independent research at the University of St Andrews led by Dr Catherine Adamson, a specialist in viral diseases, demonstrated the superior effectiveness of Alfacyte™ in vitro against SARS-CoV-2. Alfacyte™ is a synthetic molecule based on the human Alpha Interferons and was invented by Professor William Stimson, Founder and Chief Scientific Officer at ILC Therapeutics. Dr Alan Walker, CEO of ILC Therapeutics, welcomed the results as a significant development in the fight against COVID-19: “This is a very positive development as the world prepares to face a second wave. Therapeutic interventions are crucial for us to tame COVID-19. The Innate Immune System represents an immunological “wall” against viral infection. If we can hold the virus at this “wall” long enough for the Adaptive Immune Response to get ready for battle, then COVID will not be able to progress into ARDS and cause systemic damage.” The Alpha Interferons are a family of 12 natural proteins which everyone produces. Thus far only one subtype is used therapeutically, the Interferon Alpha 2. Professor William H. Stimson has spent two decades studying all the subtypes and their effectiveness as immunoregulators and antivirals, not just for COVID-19 but for other coronavirus-based illnesses such as SARS or MERS. His work has led him to construct a new patented synthetic Alpha Interferon, called Alfacyte™, based on the most effective and powerful Alpha Interferon subtypes. Professor Stimson, stated: “COVID-19 and other coronaviruses have spent a lot of evolutionary energy trying to protect themselves against the Interferon alpha because overcoming the Innate Immune System is their main concern. They attack by delaying the production of Interferon alpha and so break through the Innate Immune defensive wall before the Adaptive Immune System is prepared to fight them. Timing is everything and by delivering a powerful Interferon like Alfacyte™ to the airways using a nebuliser we hope to accelerate and support the Innate Immune defences and prevent viral infection spreading and worsening. As well as having direct anti-viral activity Alfacyte™ is a powerful stimulator of Natural Killer (NK) cells that play a critical role if defending against the spread of COVID-19. These properties make Alfacyte™ an extremely promising drug candidate for COVID-19 therapy.” The University of St Andrews’ Dr Catherine Adamson, who oversaw the tests, said: “This is a hugely exciting development and it demonstrates that there is a significant difference in the bioactivity of Interferon sub types against Coronaviruses. These differences may have important therapeutic implications for COVID-19.” ILC Therapeutics is in the process of conducting further testing of Alfacyte™ and hopes to proceed to clinical trials by next year.

 See also: Everything Contagion got right on the Coronavirus outbreak

Decline of Humoral Responses against SARS-CoV-2 Spike in Convalescent Individuals By Guillaume Beaudoin-Bussières, Annemarie Laumaea, Sai Priya Anand, et al. mBio 1: e02590-20 Source: https://mbio.asm.org/content/11/5/e02590-20

In the absence of effective vaccines and with limited therapeutic options, convalescent plasma is being collected across the globe for potential transfusion to coronavirus disease 2019 (COVID-19) patients. The therapy has been deemed safe, and several clinical trials assessing its efficacy are ongoing. While it remains to be formally proven, the presence of

www.cbrne-terrorism-newsletter.com 210 HZS C2BRNE DIARY – October 2020 neutralizing antibodies is thought to play a positive role in the efficacy of this treatment. Indeed, neutralizing titers of ≥1:160 have been recommended in some convalescent plasma trials for inclusion. Here, we performed repeated analyses at 1-month intervals on 31 convalescent individuals to evaluate how the humoral responses against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Spike glycoprotein, including neutralization, evolve over time. We observed that the levels of receptor-binding- domain (RBD)-specific IgG and IgA slightly decreased between 6 and 10 weeks after the onset of symptoms but that RBD- specific IgM levels decreased much more abruptly. Similarly, we observed a significant decrease in the capacity of convalescent plasma to neutralize pseudoparticles bearing wild-type SARS-CoV-2 S or its D614G variant. If neutralization activity proves to be an important factor in the clinical efficacy of convalescent plasma transfer, our results suggest that plasma from convalescent donors should be recovered rapidly after the resolution of symptoms.

PharmaMar plots Phase III trial after Aplidin shows promise in COVID-19 Source: https://www.thepharmaletter.com/article/pharmamar-plots-phase-iii-trial-after-aplidin-shows-promise-in-covid-19

Oct 16 – Shares in Spanish drugmaker PharmaMar (MSE: PHM) were more than 6% higher on Friday afternoon. The company had just announced that its APLICOV-PC clinical trial of Aplidin (plitidepsin) for the treatment of adult patients with COVID-19, who required hospitalization, has achieved both its primary safety and secondary efficacy endpoints. There were three different patient cohorts, with three different plitidepsin dose levels, administered over three consecutive days, evaluated in the study, in patients with COVID-19 who required being admitted to hospital. The patients' viral load was evaluated quantitatively, at the same center, at the beginning of the treatment and on days four, seven, 15 and 30. The study has demonstrated a substantial reduction of the viral load in patients between days four and seven from starting the treatment, the average reduction of the viral load on day seven was 50% and on day 15, 70%. More than 90% of the patients included in the trial had medium or high viral loads on beginning the treatment. Some 80.7% of patients were discharged on or before the 15th day of hospitalization, and 38.2% before the eight day. According to the protocol, they must be hospitalized for a minimum of seven days. A remarkable correlation was observed between the decrease in viral load, the clinical improvement and the resolution of pneumonia, as well as a drop in inflammation parameters, such as the C-reactive protein. By day 30, on the programmed visit to the clinic, none of the patients treated with plitidepsin had developed any signs or symptoms of COVID-19. These results confirm both the safety, already observed in other studies with approximately 1,300 cancer patients treated at much higher doses, and the activity already seen in in vitro and in vivo studies carried out at different prestigious international laboratories.

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Following the results obtained in this first group of patients and discussions with the Spanish Agency for Medicines and Healthcare Products, in order to keep the study open in hospitals, and to allow patient access to plitidepsin, PharmaMar has obtained authorization for an extension of the patient cohort. This extension will help to obtain more data on the treatment of this indication.

Plitidepsin (also known as dehydrodidemnin B) is a chemical compound extracted from the ascidian Aplidium albicans.

With these data, the company will begin, in the next few days, conversations with regulatory agencies to define the Phase III pivotal study for plitidepsin in patients with COVID-19, who require hospitalization.

The enemy

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Living novel coronavirus on the outer packaging of imported frozen cod Source: https://www.cgtn.com/special/Global-COVID-19-cases-top-19-7-million-U-S-cases-exceed-5-million.html

Oct 18 – The Chinese Center for Disease Control and Prevention (CDC) on Saturday confirmed the detection and isolation of living novel coronavirus on the outer packaging of imported frozen cod in the eastern coastal city of Qingdao. The finding was made during an investigation to trace the source of recent infections reported in the city. It has proved that contact with packaging contaminated by living novel coronavirus could lead to infection, the China CDC announced on its website. It is the first time in the world that living novel coronavirus has been isolated from the outer packaging of cold-chain food, the China CDC said. The agency said that the risk of cold-chain food circulating in China's market being contaminated by the novel coronavirus is very low, citing recent nucleic acid test results for samples taken from the business. A total of 2.98 million samples had been tested across the country's 24 provincial-level regions by September 15, including 670,000 taken from cold-chain food or food packagings, 1.24 million from working staff and 1.07 million from the environment. Only 22 samples from cold-chain food or food packagings tested positive for the virus, the China CDC said.

This 14-year-old girl won a $25K prize for a discovery that could lead to a cure for Covid-19 Source: https://edition.cnn.com/2020/10/18/us/anika-chebrolu-covid-treatment-award-scn-trnd/index.html

Oct 19 – As scientists around the world race to find a treatment for the coronavirus, a young girl among them stands out.

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Anika Chebrolu, a 14-year-old from Frisco, Texas, has just won the 2020 3M Young Scientist Challenge -- and a $25,000 prize -- for a discovery that could provide a potential therapy to Covid-19. Anika's winning invention uses in-silico methodology to discover a lead molecule that can selectively bind to the spike protein of the SARS-CoV-2 virus. "The last two days, I saw that there is a lot of media hype about my project since it involves the SARS-CoV-2 virus and it reflects our collective hopes to end this pandemic as I, like everyone else, wish that we go back to our normal lives soon," Anika told CNN. The coronavirus has killed more than 1.1 million people globally since China reported its first case to the World Health Organization (WHO) in December. The United States has more than 219,000 deaths, according to data from the Johns Hopkins University Center for Systems Science and Engineering. Anika, who is Indian American, submitted her project when she was in 8th grade -- but it wasn't always going to be focused on finding a cure for Covid-19. Initially, her goal was to use in-silico methods to identify a lead compound that could bind to a protein of the influenza virus. "After spending so much time researching about pandemics, viruses and drug discovery, it was crazy to think that I was actually living through something like this," Anika said. "Because of the immense severity of the Covid-19 pandemic and the drastic impact it had made on the world in such a short time, I, with the help of my mentor, changed directions to target the SARS-CoV-2 virus." Anika said she was inspired to find potential cures to viruses after learning about the 1918 flu pandemic and finding out how many people die every year in the United States despite annual vaccinations and anti-influenza drugs on the market. on "Anika has an inquisitive mind and used her curiosity to ask questions about a vaccine for Covid-19," Dr. Cindy Moss, a judge for the 3M Young Scientist Challenge, told CNN. "Her work was comprehensive and examined numerous databases. She also developed an understanding of the innovation process and is a masterful communicator. Her willingness to use her time and talent to help make the world a better place gives us all hope." Anika said winning the prize and title of top young scientist is an honor, but her work isn't done. Her next goal, she says, is to work alongside scientists and researchers who are fighting to "control the morbidity and mortality" of the pandemic by developing her findings into an actual cure for the virus. "My effort to find a lead compound to bind to the spike protein of the SARS-CoV-2 virus this summer may appear to be a drop in the ocean, but still adds to all these efforts," she said. "How I develop this molecule further with the help of virologists and drug development specialists will determine the success of these efforts." Of course, Anika also finds time to be normal 14-year-old. When she isn't in a lab or working toward her goal of becoming a doctor or researcher, Anika trains for the Indian classical dance called Bharatanatyam, which she has been practicing for eight years.

Coronavirus Survives on Skin For 9 Hours, Longer Than Flu Pathogen: Study Source: https://www.ndtv.com/world-news/coronavirus-survives-on-skin-5-times-longer-than-flu-study-2311853

Oct 18 – The coronavirus remains active on human skin for nine hours, Japanese researchers have found, in a discovery they said showed the need for frequent hand washing to combat the Covid-19 pandemic. The pathogen that causes the flu survives on human skin for about 1.8 hours by comparison, said the study published this month in the Clinical Infectious Diseases journal. "The nine-hour survival of SARS-CoV-2 (the virus strain that causes Covid- 19) on human skin may increase the risk of contact transmission in comparison with IAV (influenza A virus), thus accelerating the pandemic," it said. The research team tested skin collected from autopsy specimens, about one day after death. Both the coronavirus and the flu virus are inactivated within 15 seconds by applying ethanol, which is used in hand sanitisers. "The longer survival of SARS-CoV-2 on the skin increases contact-transmission risk; however, hand hygiene can reduce this risk," the study said. The study backs World Health Organization guidance for regular and thorough hand washing to limit transmission of the virus, which has infected nearly 40 million people around the world since it first emerged in China late last year.

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Covid-19: The global crisis — in data Charts and maps show paradoxes of a pandemic that has claimed a million live Source: https://ig.ft.com/coronavirus-global-data/

Data has been the only way to truly understand the scale and impact of Covid-19. As part of a major new series, the Financial Times has compiled chronological chapters of the crisis using information drawn from around the world. Individually, each tells a small yet important part of the story. Collectively, they help explain the virus’s enormous death toll — and why its impact will last for years to come.

EDITOR’S COMMENT: A very interesting link with many graphics that explain the global reaction to the ongoing pandemic. Keep it your files.

The spread of coronavirus Source: https://www.thenationalnews.com/uae/coronavirus

EDITOR’S COMMENT: I do not know how long they will keep this timeline but it is very impressive and worth watching!

Wastewater Requires Additional Treatment to Reduce Spread of Coronavirus Source: https://www.medrxiv.org/content/10.1101/2020.10.14.20212837v1

Oct 19 – Wastewater must be further treated to minimize the risk of dissemination and infection of SARS-CoV-2, according to Ben- Gurion University of the Negev (BGU) researchers, who found coronavirus RNA in samples from Israeli water treatment plants. Published in medRxiv in advance of peer review, this is the first research on the presence of SARS-CoV-2 in water treatment stages. Sewage originating from areas facing COVID-19 outbreak carry SARS-CoV-2 to wastewater treatment plants in urine and feces shed by those who are infected. The BGU research team analyzed wastewater samples at several treatment stages collected during the April lockdown and a second wave in July. “If we do not want recurring waves of outbreaks, we must reduce the infection and neutralize wastewater treatment as well,” says co-lead researcher Dr. Oded Nir of the Zuckerberg Institute for Water Research, part of BGU’s Jacob Blaustein Institutes for Desert Research. “Overall, our results highlight the need for further research on the occurrence and infectivity of SARS-CoV-2 in treated and untreated wastewater.” While most of the sewage in the United States, Israel and other developed countries undergoes biological treatment before release to the environment or reuse, the researchers found that existing processes were inadequate to reduce the virus concentration to undetectable levels. In countries and areas where water is left untreated, it can be a conduit for infection of people and animals.

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According to the BGU researchers, when treated with chlorine, the virus was no longer detectable. While, chlorination was found to be effective in removing the virus, determining the proper levels will be required to ensure complete removal of SARS-CoV- 2 traces. “While utilities are now looking at their water samples to detect COVID-19, BGU’s water researchers are leading the way in determining how to remove the virus to keep communities safe,” says Doug Seserman, chief executive officer of American Associates, Ben-Gurion University of the Negev. “This is just one of a number of BGU’s COVID-19 projects that address water detection and water treatment, thanks in part to emergency funds provided by American donors.”

India's Tata group claims 45-minute paper-strip Covid-19 test ready this month Source: https://www.thenationalnews.com/uae/science/india-s-tata-group-claims-45-minute-paper-strip-covid-19-test-ready-this- month-1.1096613

Oct 20 – The Feluda kit, named after the fictional Bengali detective (also serves as an acronym for the FNCAS9 Editor Linked Uniform Detection Assay), would cost just $7 India's Tata group said it will soon roll out a low-cost Covid test that gives results in 45 minutes. The test involves a nasal swab and the results can be delivered using a simple paper strip, similar to a pregnancy test. Tata's health division chief set out details of the potential breakthrough screening at a UAE-India health forum, attended by government officials from both countries, this week. He said the Feluda test, named after a fictional Bengali detective, could be made available by the end of the month. “The benefits in the current pandemic is that it is simple, reliable, highly scalable and this test does not require expensive machines,” said Girish Krishnamurthy, chief executive of Tata Medical and Diagnostics, at a virtual event organised by the Indian consulate in Dubai. “The turnaround time is very quick. In 45 minutes, you can get the viral test and nucleic acid test and more importantly a tamperproof result," he said. "The product is being tested and is in production mode. “We are looking to offer it to the world by the end of this month and from that point of time we will start moving a significantly large volume for the world. “We have interest coming from the UAE and this test will be available very, very soon for your country.”

The Tata group has set up a large plant in India to produce a sizeable volume and is in talks with laboratories and hospitals. “In the next two to three months, we will be in a position to handle demand from India as well as global demand," he said. Dr Harsh Vardhan, India’s federal health minister, last week said the test had been approved by the Drug Controller General of India for a commercial launch. Based on tests during trials and in private labs, Feluda showed 96 per cent sensitivity and 98 per cent specificity. The accuracy of a kit is based on these two indicators – a highly sensitive test can detect almost everyone who has the virus. And a high specificity rate will accurately rule out people who don’t have the disease, ensuring fewer false negative and false positive results. The test was developed by a team at the Delhi's CSIR-Institute of Genomics and Integrative Biology, led by Dr Souvik Maiti and Dr Debojyoti Chakraborty. The main advantage is fast results, affordability, ease of use and mass testing. “We are working on the next version of this test which can be tested by saliva,” Mr Krishnamurthy said.

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“It will not only reduce the time to less than 20 minutes, it is going to reduce the cost significantly.” He said such breakthroughs were required to get people back in factories, schools, colleges and sporting events. The Feluda test uses Crispr technology, short for Clustered Regularly Interspaced Short Palindromic Repeats, or very precise gene-editing to sense the virus. Several research companies in the US and UK are developing similar paper-st rip tests. The technique can detect specific sequences of DNA within a gene so it is capable of detecting even low quantities of the genetic material of the coronavirus.

Mouthwash May Help to Neutralise Coronavirus, Experiment with Human Cells Suggests Source: https://www.sciencealert.com/mouthwash-may-help-to-neutralise-coronavirus-experiment-with-human-cells-suggests

Oct 21 – A range of common household items – including mouthwash, nasal rinses, and even diluted baby shampoo – have been found to inactivate a form of human coronavirus in new research, highlighting another potential avenue to reduce transmission rates amid the ongoing COVID–19 pandemic. Before we go any further, it's worth pointing out that nobody is suggesting mouthwash is some kind of silver bullet that can protect you from a virus that has killed over 1 million people so far, as that's not what this research is demonstrating, nor recommending. For starters, nobody gargled oral rinses as part of these new experiments, which were performed in the lab using cultured human cells in solutions. In other words, we haven't yet tested in people the effects of using products like mouthwash on coronaviruses. Also, it's worth noting the scientists in this study used a form of coronavirus called HCoV‐229e – not SARS-CoV–2, which is the specific coronavirus behind the disease COVID–19. As both the viruses are genetically similar, the experiment's results are expected to broadly be the same, but it's another reason not to think that mouthwash use in real life confers any protective benefits, as that hasn't actually been shown. Nonetheless, while health authorities strive to debunk popular misconceptions about supposed coronavirus defences in the background, scientists have been calling for more research investigating how products like mouthwash might interact with and inactivate SARS-CoV-2, due to the presence of chemicals known to disrupt viral membranes. To examine this, a team from Penn State University exposed human liver cells in culture with mixed solutions containing HCoV‐229e and either mouthwash, a nasal rinse product, or baby shampoo diluted to 1 percent. Tests revealed that all of the products were effective at inactivating the virus, although the extent of the effects varied between products, and depended on how long the products were in contact with the virus. "With contact times of 1 and 2 minutes, the 1 percent baby shampoo solution was able to inactivate more than 99 percent and more than 99.9 percent or more of the virus, respectively," the researchers write in their paper. Among the oral rinses, many of the products tested inactivated 99.99 percent of the virus after 30 seconds, and when incubation times grew longer than that (1 and 2 minutes), the researchers couldn't detect any remaining infectious virus in the cells. The findings support earlier research from Germany published in July, which also suggested exposure to mouthwash could significantly reduce the viral load of coronavirus. It's worth pointing out, too, that the German study used SARS-CoV-2 in the experiments, which were otherwise similar to the Penn State study.

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Nonetheless, neither of these studies can guarantee we'd see the same outcomes in tests with human participants, and there's a lot we don't know about how products like mouthwash and oral rinses might function in real-world scenarios. Still, given the kind of positive results we're seeing in experiments like this – and given how few defences we currently have against coronavirus, beyond common staples such as physical distancing, hand-washing, and wearing masks – the researchers say we should be looking at clinical trials to evaluate whether products like mouthwash can actually reduce viral load in COVID-19-positive patients, too. "Clinical trials are needed to determine if these products can reduce the amount of virus COVID-positive patients or those with high- risk occupations may spread while talking, coughing, or sneezing," says microbiologist Craig Meyers, the first author of the study. "Even if the use of these solutions could reduce transmission by 50 percent, it would have a major impact."

 The findings are reported in Journal of Medical Virology.

Neuropilin-1 facilitates SARS-CoV-2 cell entry and infectivity By Ludovico Cantuti-Castelvetri, Ravi Ojha, Liliana D. Pedro, et al. Science 20 Oct 2020: eabd2985 Source 1: https://science.sciencemag.org/content/early/2020/10/19/science.abd2985 Source 2: https://www.genengnews.com/news/sars-cov-2-uses-a-second-receptor-neuropilin-1-to-infect-human-cells/

Abstract The causative agent of coronavirus induced disease 2019 (COVID-19) is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For many viruses, tissue tropism is determined by the availability of virus receptors and entry cofactors on the surface of host cells. Here, we found that neuropilin-1 (NRP1), known to bind furin-cleaved substrates, significantly potentiates SARS-CoV-2 infectivity, an effect blocked by a monoclonal blocking antibody against NRP1.

Neuropilin-1 (NRP1) is a host factor for SARS-CoV-2 infection. The image sho ws human cells infected with SARS-CoV-2 and expressing viral proteins (shown in green). Removal of NRP1 from cells or treating cells with a drug or an antibody targeting NRP1 reduces SARS-CoV-2 infection. [The University of Bristol]

A SARS-CoV-2 mutant with an altered furin cleavage site did not depend on NRP1 for infectivity. Pathological analysis of human COVID-19 autopsies revealed SARS-CoV-2 infected cells including olfactory neuronal cells facing the nasal cavity positive for NRP1. Our data provide insight into SARS-CoV-2 cell infectivity and define a potential target for antiviral intervention.

Volunteer in Oxford coronavirus vaccine trial dies, reportedly did not receive experimental vaccine Source: https://www.washingtonpost.com/world/the_americas/coronavirus-oxford-astrazeneca-vaccine-trial-death/2020/10/21/3f5bedac-13c0- 11eb-ad6f-36c93e6e94fb_story.html

Oct 22 – A Brazilian who participated in the clinical trial of an experimental coronavirus vaccine has died, officials here said Wednesday. Brazil’s National Health Surveillance Agency, which is overseeing multiple vaccine trials in a country suffering one of the world’s worst outbreaks, said the individual volunteered to receive the vaccine candidate developed by Oxford University and produced by AstraZeneca.

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The Brazilian newspaper O Globo, citing unnamed sources, reported that the volunteer was in a control group that did not receive the experimental vaccine and died of covid-19. The news service G1 said the volunteer was a 28-year-old physician who treated coronavirus patients in Rio de Janeiro. The National Health Surveillance Agency said it was informed of the volunteer’s death Monday. The agency said AstraZeneca’s international safety committee had recommended the trial continue. Under the trial’s protocol, half the participants receive the experimental vaccine, and half receive an established meningitis vaccine that has been proved safe. The trial, like others, is overseen by an independent board that reviews all adverse events. Any severe event that might have been caused by the vaccine would trigger a pause in the study for an investigation. The trial is not paused due to the death. A spokesman for AstraZeneca said he could not comment on individual cases in an ongoing trial, citing confidentiality requirements and clinical trial rules. But he said there were no concerns that would lead the study to pause. “We can confirm that all required review processes have been followed,” spokesman Brendan McEvoy said. “All significant medical events are carefully assessed by trial investigators, an independent safety monitoring committee and the regulatory authorities. These assessments have not led to any concerns about continuation of the ongoing study.” Oxford confirmed that the volunteer’s death was reviewed by an independent committee. “Following careful assessment of this case in Brazil, there have been no concerns about safety of the clinical trial, and the independent review in addition to the Brazilian regulator have recommended that the trial should continue,” the university said in a statement. The trial was suspended last month after a participant developed an unexplained illness. AstraZeneca has since resumed trials in Brazil, India, South Africa, Japan and Britain. It remains on hold in the United States.

Exiting the Second Lockdown, Living in the Presence of Covid-19, and Anticipating the Stage Beyond: Recommended Strategy By Amos Yadlin, Meir Elran, and Shmuel Even Source: https://www.inss.org.il/publication/inss-strategy-for-exiting-the-lockdown/

Oct 22 – This document was written a number of weeks after the second nationwide lockdown was announced. As expected, the measure succeeded in lowering the infection rate, albeit at a high economic cost and a new spike in unemployment. At the same time, Israel is witnessing rising friction with the ultra-Orthodox community, more extensive public protests, and diminishing public trust in the authorities, related in part to the government’s problematic handling of the multilayered crisis.

The purpose of this document is to propose an integrative strategy for exiting the second lockdown and returning to a new routine in the presence of Covid-19, looking at the immediate, medium, and long terms. It recommends new mechanisms to maintain public health, an optimal level of economic activity, and a functioning society. This is proposed for the long period in which coronavirus infection is expected to continue, and then the recovery phase following the pandemic. The national objectives that guide the proposed strategy are: to keep the pandemic under control, to ensure long-range national resilience, to mitigate economic and social damages, to maintain government functioning, and to prepare for the post- Covid-19 era. This proposal is based on discussions held at the Institute for National Security Studies (INSS) with the participation of Institute researchers and outside experts.

The Coronavirus Crisis as a Challenge to National Security The multilayered crisis in Israel – health, economic, societal, and political – is likely to endure for a long time. Until a comprehensive medical solution is found and implemented, Israel will have to adopt a disrupted – or certainly different routine – in the presence of the coronavirus. The consequences of this crisis may well continue for years to come, in the economy (public debt) and society (unemployment, inequality, and amplified social tensions), and perhaps also at the political level. Israel has always been a heterogeneous country, composed of diverse sectors. In the past, during security crises, the Jewish public knew how to unite and operate successfully against a defined enemy. This crucial sociopolitical phenomenon has been challenged in the current crisis, both because the virus is not an external human enemy, and because of the politicization of the crisis management. The emerging picture is characterized by a significant

www.cbrne-terrorism-newsletter.com 219 HZS C2BRNE DIARY – October 2020 decline in national solidarity, a focus on the particular interests of specific communities and sub-communities, and an unravelling of the vital connection between the political leadership and the public. Hence the significant erosion of public trust in the Prime Minister, the government, the political system in general, and to some extent, in the public service. All of these contribute to a dramatic decline in national resilience, constitute an obstacle to constructive conduct in the face of the pandemic, and create a risk to national security in the broadest sense of the term.

Summary of the Proposal (enlarge to view the actions)

The systemic lapse in planning for and managing a complex civilian crisis has been exposed. Israel entered the crisis without a national mechanism for decision making and for managing mass disasters, and has not succeeded in constructing one since the outbreak of the crisis. This has worsened Israel’s overall situation in the second wave of the pandemic. The political-legislative-leadership crisis in Israel, ongoing for almost two years, complicates any effort at campaign management. It undermines public trust in the authorities, its willingness to comply with the social restrictions, and careful defensive conduct during the pandemic. Without an end to the politicization of the crisis, reflected in part by guidelines that lack any public health justification and by apparent arbitrary and inconsistent enforcement, the public will continue to struggle to accept necessary restrictions, even as it continues to suffer what is commonly known as “pandemic fatigue.” Not one of these fundamental problems is expected to disappear in the near future, certainly not without a profound cultural-socio-political change in the State of Israel.

Basic Assumptions for the Short Term 1. The current singular crisis is caused by the coronavirus pandemic. Despite advanced efforts in the medical field, it is unclear when a comprehensive and available medical solution will be found. Therefore, a national approach should be based on managing daily life in the presence of the coronavirus for an extended period of time, while minimizing damage in the health, economic, and societal spheres. Even if a medical solution to the pandemic is found, the harsh economic and social consequences will remain for a long time. Thus, the phase of systemic recovery in the post-Covid period should be anticipated and prepared for now. 2. Uncertainty over when the pandemic will end requires careful management of budgetary, human, organizational, and other resources so they suffice for all national requirements over an extended period of time. Special attention must be given to the healthcare system to provide effective and diverse services to all sectors. Also, national resources must remain available in the short and long term, to maintain daily functioning, ensure there are sufficient resources for the future, and address unforeseen crises (for example, a security crisis).

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3. The return to the second nationwide lockdown was prompted primarily by the health-related consequences of the hasty exit from the first lockdown. As a lesson from this experience, Israel must exit the second lockdown cautiously and gradually, subject to health indexes throughout the country and in individual communities. 4. Prominent among the main hotspots that caused a surge in morbidity rates and led to the second lockdown were large gatherings in the form of religious services and events in the ultra-Orthodox sector, weddings in the Arab sector, and contagion in schools. These hotspots require careful attention and special treatment, both for health reasons and for their impact on the general public. 5. The second lockdown was imposed on a weaker Israel, in both economic and societal terms. Consequently, the exit point for the entire country and especially for socially weakened and economically challenged sectors (tourism, aviation) will also be weaker. Hence the need for a differential policy that strengthens particular sectors, with priority given to weakened sectors that have been hit particularly hard. 6. Managing the exit from the lockdown requires the application of a cost-benefit approach, balancing the health, economic, and social curves. As a guiding principle, restrictions should be eased on work and places where the health risk is relatively low and the economic and social contribution is high. For example, restrictions should remain for crowded locations, but they should be eased in spacious industrial settings. Calculated differential management of social distancing is required to save billions of shekels while carefully taking into account the level of risk.

Thresholds for Phased Exit from the Nationwide Lockdown The government has been consistently vague in setting infection thresholds that allow for easing the lockdown and for the gradual transition to a differential “traffic light” model. There are a number of reasons for this, some epidemiological, some social, and some political. Initial statements put the threshold for exiting the lockdown at a daily infection rate (N) of 2,000 new cases per day and a decrease in the reproduction rate (R) to 0.8. Indexes at that level do not allow for a broad reopening of the economy, and barely mark a cautious starting point for a gradual process of lifting restrictions. Despite the paramount importance of economic and social considerations that necessitate a gradual opening up of the economy, it is correct to delay the process of exiting the current lockdown until there is a signifcant chance of curbing the infection rates in a manner that removes the danger of a new outbreak on the scale of the September surge. Israel cannot afford to lose control of the virus again, especially in light of the coming winter and flu season. Therefore, a lower rate of coronavirus infections (500-1,000 per day) is best for commencing a nationwide easing of restrictions. Red zones should remain under lockdown until their classification is changed. This is an essential condition for success: it would enable better control of infection and morbidity and mitigate concerns of collapse of the healthcare system. The more that contagion declines and stabilizes at low levels, the more the risk of a third lockdown will decrease. Opening of the economy at low infection levels will also enable the healthcare system to manage the expected increase in infection when the restrictions are lifted. However, there can also be exceptions to this design. There are critical fields where gradual easing of restrictions can be allowed at an early stage, according to "purple standard" regulations, such as in green zones and regarding restrictions imposed without any epidemiological justification, such as the I km limit on movement from home or work, or restrictions on small-scale commerce.A critical system-wide threshold condition for easing the lockdown should be strict enforcement and prevention of mass gatherings, especially in closed spaces. In Israeli terms, this means mainly prior approval of the guideline and especially strict enforcement of restrictions on gatherings in all sectors and in all public areas. The rules for preventing gatherings should be uniform and simple. In red zones there should be tighter general enforcement. Israel should rigorously prepare for the possibility of renewed high morbidity due to the coronavirus, possibly with the influenza virus that is expected to appear in the winter. Any significant increase in morbidity should immediately lead to tightened restrictions, especially in infection hotspots.

A Multi-phased Approach to the Multilayered Crisis Notwithstanding the importance and urgency of dealing with the current acute crisis, proposed here is a national framework that addresses four interconnected components of the multilayered crisis, which require parallel planning and execution.

1. The controlled exit from the lockdown includes two reference groups: a. Guidelines for the general population:

• When possible, depending on infection levels, the lockdown will be lifted on a cautious, gradual, and differential basis. Priority should be granted to business that do not have walk-in customers and whose contribution to the GDP is high.

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• At the same time, the differential and phased opening of the education system should be allowed, with priority to pre-school to third grade, employing a full pod model without any compromises. Outdoor learning should be practiced, along with upgrading of distance learning and assistance in purchasing computers to broaden the learning circle.

• Differential (not lateral) economic compensation should be provided, with an emphasis on groups that have been hurt by the crisis more than others (in particular deciles 3-5, the self-employed, and small and medium business owners). This must be done cautiously, while preserving resources for future recovery.

• Differential enforcement will be difficult to comprehend and implement among the population. Restrictions therefore require strict enforcement, according to priorities, headed by the complete ban on mass gatherings. It is imperative to provide the police with authority, resources, and public and governmental support so that it can enforce the differential restrictions and at the same time maintain law and order and defend the democratic system. As a rule, there should be no distinction between sectors, but there must be a differentiation between red zones and other localities.

• Effective enforcement necessitates public knowledge and understanding of the specific restrictions. This calls for a professional, clear, authoritative, precise, transparent, and credible messaging system that must address the entire country, but also specific sectors and communities. The professional public messaging service should formulate the public information policy, shape daily messages, and engage in a dialogue with the public through the established media, social networks, and local authorities. This should be promoted alongside messaging efforts at the local level, which is expected to translate the general messages to the particular local communities.

• The education system demands special attention. Beyond its basic contribution to the younger generation, it enables increased employment among parents challenged by the coronavirus. Clearly the entire 2020-2021 school year will be disrupted. Activities should be planned in a differential manner on the basis of the following principles: A sharp transition from the centrality of the Ministry of Education, which should only set policy and standards, to decentralization to local authorities and educational institutes; creative solutions in the field, such as outdoor learning in small groups; preference to lower age groups and provision of emotional support; less reliance on distance learning; for older students, focus on core subjects only; and above all, assistance to weaker populations as a priority b. Establishing a Professional Organizational Framework • Israel is at a critical stage that requires decision making processes based on clear and credible information and data and professional considerations that take into account the risks for the immediate, medium, and long terms. Israel is currently far from possessing the competence required to manage complex crises such as the current one. Hence, a small professional state mechanism to support the political decision making and the implementation of policy should be established immediately, even if this is a belated measure. Such a mechanism should manage the entire scope of the interconnected multilayered crisis and integrate government and public systems, while working under the supervision of the Coronavirus Cabinet. Such a change is necessary and possible if the Prime Minister, together with the Coronavirus Cabinet, concentrates on setting the grand policy and allows the designated central organ to do its job. • Increased cooperation with the local authorities is required, along with added responsibility placed on services granted locally, in close cooperation with the IDF Home Front Command. Not all local authorities are up to the task; however, most can assist in relating to residents, primarily those who require specialized help. In large towns it is also important to build community networks and to recruit volunteers among the youth, senor citizens, and others. Local authorities should be funded in order to support weaker populations. Delegation of powers to local authorities should be considered, including in the field of enforcement. The overall main purpose is to empower local authorities and society in its entirety. • The national budget for the years 2020 and 2021 should be passed immediately, including a detailed economic plan for the coming year and a less detailed plan for the following period. In the absence of a budget, the government will struggle to perform and Israel’s credit rating will be at risk. • A concerted effort should be made to improve the medical system’s capabilities to treat coronavirus patients in severe condition while at the same time minimizing the damage to essential services to other groups. At the same time, testing for infection must be enhanced – both serological tests to check the immunity of patients who

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have recovered from the coronavirus and mass testing capacities should be introduced to enable the monitoring of large numbers of patients. Fast completion of the contact tracing mechanism should be ensured, to break chains of infection. • A central national data and research center for all fields related to the multilayered crisis should be established. The center should coordinate data gathering efforts according to needs, and should analyze and distribute its findings to decision makers and the general public with maximum transparency.

2. Differential Management of the New Routine in the Presence of the Coronavirus The working assumption should be that the next phase will continue until the end of 2021. The primary goal in this phase needs to be minimizing damage to the economy and society while weathering the continued reality of the coronavirus. During this period, a balance is required between medical, economic, and social considerations, with priority to the former. Management of this phase should be based on professional, not political considerations. As to the operation of differential tools: we endorse the differential- geographic approach based on the traffic light model, even if it presents a serious political challenge. Israel is a densely populated small country, and geographical differentiation between localities is difficult to implement. “Mixing” of populations is common and isolation of communities in question is difficult. Also, decisions to isolate entire (red) communities, which are commonly ultra- Orthodox, will face political and social challenges. Hence, it is possible and necessary to rely primarily on a differential-functional approach (to complement the differential-geographic approach). This would mean, for an example, opening businesses without walk-in customers, schools for younger children, and services for the elderly in accordance with risk levels. This principle can also be implemented regarding public welfare and leisure activity.

3. Attention to the Recovery Stages The second phase is expected to take a long time, and will not end abruptly on a given date. The main challenge thereafter will be economic recovery through rapid growth and a sharp reduction in unemployment. Therefore, parallel to the ongoing management of the acute crisis, planning for the post-coronavirus phase should commence early, with a view to enable and promote "bouncing back" through economic growth. This is a national mission of major gravity that necessitates a broad consensus, complex and multi- dimensional systemic planning, cautious decision making based on choice between various alternatives, and above all, the investment of significant resources. This is a huge challenge due to the national expenditure involved. Examples of issues that should already be addressed: planning and execution of large-scale professional training, acceleration of digital transformation processes; enhancement of communication infrastructures, and technologies that will broaden the possibilities for distance work and learning. This is an opportunity that may enable easing of some of the bottlenecks that afflict Israel in transportation, housing, and office space. The assumption is that some patterns of life in the post-coronavirus period will be very different from those that preceded the crisis. In addition, there will also be the need to focus on assistance to those who were left behind. One of the main efforts required will be to expand employment opportunities for the unemployed. The goal will be to restore unemployment to a level of around 4 percent by the end of the period, alongside an improvement in work productivity. Later in the period, there will be a need to reduce the budget deficit and the debt-to-GDP ratio, in order to return to levels that were standard prior to the crisis.

4. Public Reforms to Deal with Future National Challenges The main opportunity presented by the pandemic is to draw basic lessons from the current crisis and build mechanisms to prepare for national disasters, while learning how to live normally during such disasters without giving up on democracy. This will require a concerted effort to create a series of profound changes in fundamental cultural, social, economic, and political domains, whose weaknesses have emerged in the current period. This is a process in which government and society must work together on the basis of a renewed social accord.

Conclusion The assumption that Israel can successfully deal with the current crisis with existing tools seems unfounded. Israel must, from now until the end of the second lockdown, make a series of fundamental decisions, centering on the recognition that it is necessary to formulate a new comprehensive policy based on quantifiable national goals, along with the establishment of mechanisms to manage the multilayered crisis and the eventual recovery from it. The immediate goal is to contain the pandemic. This will take time. Only after that will it be possible to open the economy in phases, in a cautious and gradual manner. Israel needs to

www.cbrne-terrorism-newsletter.com 223 HZS C2BRNE DIARY – October 2020 rely on a differential-functional approach to prevent a third lockdown. The next goal is stabilization, probably long-term, based on a different routine of life in the presence of the coronavirus. During this prolonged phase Israel must prepare the long-term process of socio-economic and political recovery and growth, so as to try to ensure its success.

Amos Yadlin was named Executive Director of Tel Aviv University’s Institute for National Security Studies (INSS) in November 2011, after more than 40 years of service in the Israel Defense Forces, nine of which he was a member of the IDF General Staff. From 2006-2010, Maj. Gen. (ret.) Yadlin served as the IDF’s chief of Military Intelligence. Prior to that, he served as the IDF attaché to the United States. In February 2002, he earned the rank of major general and was named commander of the IDF Military Colleges and the National Defense College. Maj. Gen. (ret.) Yadlin, a former deputy commander of the Israel Air Force, has commanded two fighter squadrons and two airbases. He has also served as Head of IAF Planning Department (1990-1993). He accumulated about 5,000 flight hours and flew more than 250 combat missions behind enemy lines. He participated in the Yom Kippur War (1973), Operation Peace for Galilee (1982), and Operation Tamuz – the destruction of the Osirak nuclear reactor in Iraq (1981). Maj. Gen. (ret.) Yadlin earned a B.A. with honors in economics and business administration from Ben-Gurion University of the Negev (1985). He also holds a Master's degree in Public Administration from the John F. Kennedy School of Government at Harvard University. Dr. Meir Elran is a senior research fellow and head of the Homeland Security Program, the research program on the Arab citizens in Israel and the Society–Military Program of INSS. Brig. Gen. (ret.) Elran served in the IDF as a career officer for 24 years in senior command and staff positions, primarily in the Military Intelligence Directorate. His last post was deputy director of Military Intelligence (1987-1989). Brig. Gen. (ret.) Elran took an active role in the peace talks with Egypt and was an active member of the military delegation to the peace talks with the Hashemite Kingdom of Jordan. Elran holds BA degree from the Hebrew University in Jerusalem in Political Science and Middle East Studies (1965), MA degree from Indiana University in International Relations and Russian Studies (1970), and PhD in Political Science from the Haifa University (2017). Shmuel Even, who earned his Sc.D. at the Technion and the University of Haifa, is an economist and a senior research fellow at INSS. As the owner of Multi Concept (Consultants) Ltd., Dr. Even is involved in business research and consulting in the fields of business, management, and strategy. Previously Dr. Even served as the head of the Tnuva group; as a partner in a banking investment company; and as a financial consultant to leading companies in Israel. Dr. Even retired from the IDF with the rank of colonel, following a long career in the IDF's Intelligence Branch. Dr. Even's fields of research at INSS include: the Israeli economy; intellectual prperty; the gas and oil markets; national security strategy; defense expenditures; cyber issues; intelligence; the political process with the Palestinians; and more. Among his recent monographs: The Intelligence Community - Where To? (with Amos Granit, 2009); and Cyber Warfare: Concepts, Trends, and Implications for Israel (with David Siman-Tov, 2011).

Some COVID-19 Vaccine Candidates May Make People More Vulnerable to HIV, Scientists Warn By Tessa Koumoundouros Source: https://www.sciencealert.com/some-vaccine-candidates-could-make-people-more-susceptible-to-hiv-warn- immunologists

Oct 22 – As the coronavirus pandemic drags on, subsequent waves of infections are reaching staggering new heights, and more people are losing loved ones. Regardless of how each country has chosen to meet this challenge, economies are struggling, causing businesses to fail and taking away people's livelihoods. Our world is screaming out for a vaccine like never before. But now a group of researchers have warned that at least four of the current batch of potential vaccines undergoing clinical trials involve a component that might increase people's risk of contracting HIV. One of these vaccine candidates passed its phase 2 trial in August and is about to undergo a large phase 3 study in Russia and Pakistan. The warning comes from a team of scientists led by Susan Buchbinder, a University of California San Francisco professor who runs the HIV Prevention Research in the San Francisco Department of Public Health. The team experienced a similar issue first-hand while trying to develop a vaccine for HIV. To their dismay their most promising candidate after 20 years of research backfired, leaving some patients even more vulnerable to the disease. They shared their 'cautionary tale' in The Lancet.

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"We are concerned that use of an Ad5 vector for immunisation against SARS-CoV-2 could similarly increase the risk of HIV-1 acquisition among men who receive the vaccine," they wrote. Vaccines require a vehicle of sorts to deliver them to their required locations. This is called a vector and it is this component of the vaccine that is causing some concern. Several coronavirus vaccine candidates are using adenoviruses as these vectors. For example, in one trial a genetically modified adenovirus is being used to deliver the gene code of the coronavirus spike proteins, so that our immune system can learn to recognise the spike, and therefore SARS-COV-2, as an invader Adenoviruses are usually harmless aside from causing colds, and other vaccines have successfully used different modified versions of them as vectors without any evidence of increased risk of HIV. But four coronavirus candidate vaccines are using a vector called Ad5 (recombinant adenovirus type-5), and it was this that caused problems in the HIV vaccine. A decade ago, when Buchbinder and her colleagues tried to do something similar to protect against HIV, two trials led to men having an increased risk of catching HIV, particularly if they had already been infected with Ad5 in the past. While the mechanism behind this is still unclear, one 2008 study suggests it may have something to do with increased activation of the immune system providing HIV with more cells to target. In 2014, a review led by immunologist Anthony Fauci, Director of NIAID, recommended caution when using this vector in vaccines for regions with HIV prevalence. "This important safety consideration should be thoroughly evaluated before further development of Ad5 vaccines for SARS-CoV- 2," The Lancet correspondence concludes. But companies developing these vaccines have said they're aware of this problem and taking the risks into account. One company, ImmunityBio, told Science their Ad5 vector has been genetically 'muted' to decrease the level of immune response it triggers. If all goes well with their California trial they hope to test it in South Africa next. Head of the South African Medical Research Council Glenda Gray who worked on the HIV vaccines with the authors of The Lancet correspondence explains just avoiding this vector may not be the best solution. "What if this vaccine is the most effective vaccine?" she asked Science, saying that each country's experts must be allowed to make their own decision. The good news is, the scientific community is discussing this risk, and this is the type of adverse reaction that trials can help to find out. Once vaccines have passed through clinical trials they have an incredible record for being very safe. In the case of Buchbinder's HIV vaccine, this vigorous testing process worked as it should to pick up the problems with the vaccine before it was released. Teams of researchers around the world are working hard to ensure this is also being applied in the development of a COVID-19 vaccine. So far several vaccine trials have been paused for reassessment over safety concerns. Hopefully not all trials will be met with such issues. The whole world is watching closely.

 You can read the full correspondence published in The Lancet here.

Tessa Koumoundouros is an Editorial Assistant and Journalist at ScienceAlert. She adores all living things, so it’s no surprise she mainly writes about biology, health, and the environment. She holds a Bachelor of Science with honours, majoring in zoology and genetics, and a Masters in Science Communication. She has also worked as an exotics veterinary nurse, before joining the ScienceAlert editorial team in 2018.

Will We Ever Get to 'Zero COVID-19'? An Immunologist Weighs In By Kingston Mills Source: https://www.sciencealert.com/wiping-out-covid-19-completely-isn-t-a-realistic-goal-at-least- for-now

Oct 21 – Most scientists agree that stringent control measures, involving efficient contact tracing, testing and isolation, together with social distancing and mask wearing, are required to limit the spread of SARS-CoV-2. South Korea, Taiwan, China, and New Zealand have all successfully used these approaches to suppress the virus.

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A few have even called for a zero COVID-19 approach, attempting to eliminate the virus rather than contain its spread. New Zealand almost succeeded but, after 100 days without a case, new infections emerged from international travel and other unknown sources. While it's possible to flatten the curve using these control measures, getting to zero COVID-19 with them is more difficult. It might be possible for some island countries, but New Zealand's example shows that it's then necessary to prevent the virus from being re-imported. This would probably require prolonged and severe travel restrictions and rigorous testing of passengers pre- and post-travel. Given there's little appetite for prolonged closure of borders, and community control measures alone aren't enough to eliminate the virus, getting to zero isn't currently possible. But it could be in the future if we use different approaches.

Immunity is the best strategy The most effective way of containing COVID-19 exploits the body's natural defence mechanism: the immune system. Recovering from a viral infection is usually associated with the development of immunity. Whether infection with SARS-CoV-2 protects against reinfection is not yet known, but there are very few examples of people getting reinfected. Most infected people develop antibodies against the virus, and while those who don't develop symptoms may not generate antibodies, infection can still activate the immune system's T cells, which provide an alternative defence. So it seems infection generates immunity in the majority of people, at least in the short term. Knowing this, some scientists have recently suggested the virus should be allowed to spread though the population – while protecting the old and vulnerable – to allow herd immunity to develop. This is where enough people in a population have become immune to stop a disease from spreading freely. The threshold for this happening is as high as 90-95 percent for a highly transmissible virus like measles. Some have suggested it may be as low as 50 percent for SARS-CoV-2. The consensus is that it will be around 60-70 percent. But the percentage of people who have been infected with SARS-CoV-2 and recovered is currently nowhere near this. Studies that test for antibodies suggest that about 3 percent of people in Dublin have had the virus. In New York City, that figure is much higher: 23 percent. But the high rate of infection in New York has resulted in many more people there dying, even taking into account its larger population. And Sweden, which adopted a liberal policy on containing the pandemic that resulted in a high number of cases, has had 10 times as many deaths per million people as neighbouring Finland and Norway. The impact of a second wave will likely be lower in places like these, where many people have already been infected, but if the threshold for herd immunity hasn't been reached, the population as a whole still won't be protected. And the consequence of attempting to reach that threshold through natural infection will be many more deaths in at-risk groups: older people, people with obesity and those with underlying medical conditions. On top of this, some who are infected go on to develop long-term health complications, even if their initial infection isn't too severe. So, for most, the associated risks of pursuing herd immunity make it an unacceptable strategy for suppressing the virus, let alone eliminating it.

Vaccines won't be a quick fix However, achieving herd immunity through vaccination has, in theory, the potential of getting us to the elusive zero COVID-19. Vaccines have reduced the incidence of diphtheria, tetanus, measles, mumps, rubella and haemophilus influenzae type B to close to zero in many developed countries. There are more than 200 vaccines in development against SARS-CoV-2. But to have one eliminate COVID-19 is a high bar. Any vaccine would need to be highly effective at both preventing the disease and stopping the virus spreading to people who haven't had it. The vaccines currently furthest along in development, however, have set their sights on a much lower target: of being at least 50 percent effective, which is the threshold needed for them to be approved by the US Food and Drug Administration. Creating a highly effective vaccine at the first attempt might be over-optimistic. Vaccines will also need to be effective across all age groups and safe to administer to the whole population. Safety is key, as any concerns in any age group will reduce confidence and uptake. The vaccine will also need to be produced in sufficient quantities to vaccinate over 7 billion people, which will take time.

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For example, AstraZeneca – which is developing one of the leading vaccines – has deals in place to produce 2 billion doses by the end of 2021. Making enough for the whole world could take years. The impact won't be instantaneous either. The last natural smallpox case was in 1977, 10 years after the World Health Organization launched a global eradication programme for that disease, and nearly 200 years after the first smallpox vaccine was developed. And it's taken more than 30 years since the launch of Global Polio Eradication Initiative to eliminate polio everywhere except Pakistan and Afghanistan. So, while an effective vaccine offers the best chance of reaching zero COVID-19, we should be realistic about what's possible. Eliminating the virus across much of the world, while not unthinkable, could take a significant number of years.

Kingston Mills is Professor of Experimental Immunology @ Trinity College Dublin.

The Tree That Could Help Stop the Pandemic Βy Brendan Borrell Source: https://www.theatlantic.com/science/archive/2020/10/single-tree-species-may-hold-key-coronavirus-vaccine/616792/

Oct 21 – In early April, Paul Hiley was kicking back in the executive suite at Desert King International LLC, gazing out the window at the San Diego sunshine and daydreaming about his golf game. California had issued its initial stay-at-home order for COVID-19, but apart from the hand sanitizer around the office, life was more or less normal. Retirement was on the horizon for Hiley. Maybe he’d sell the business. Maybe his son, Damian, would take over. For more than 42 years, Hiley has been a leading purveyor of certain plant- based food additives suc h as saponins, foaming agents used in root beer and Slurpees. Most of us never think about these compounds, and Hiley has always liked it that way. “My theory of business is the only two people who need to know my name are my wife and my banker,” he told me recently. Then, one day—April 14th, to be exact—his son told him that they had a call with Stanley Erck. Erck is the CEO of Novavax, a Maryland-based maker of vaccines. Not a seller of vaccines, mind you: The company had yet to bring one of its candidates to market. But like other companies around the world, Novavax had thrown its hat into the coronavirus-vaccine race. And its success, Erck believed, depended on that odd ingredient in Slurpees. The inner bark of the Chilean soapbark tree, Quillaja saponaria, is the source material for some of these saponins. Pulverized and soaked in water at the Desert King factory in Chile, the bark is transformed into a brown, bitter, bubbly fluid. This precious goo does many things well, and it happens to be the raw material for one of the world’s most coveted vaccine adjuvants: QS-21. Adjuvants are compounds that boost the body’s immune reaction to a vaccine. Owing to their potential risks to human health, however, only a handful of adjuvants have been approved by the U.S. Food and Drug Administration, and QS-21 is one of the newest. A single gram of powdered QS-21 costs more than $100,000, though only about $5 worth is needed for each shot. Nine years ago, researchers estimated that the global supply of pharmaceutical-grade Quillaja extract was sufficient for just 6 million doses of vaccine. Everyone in the business knew the story of the Pacific yew tree, whose bark was the original source of the chemotherapy drug paclitaxel, and which was threatened by large-scale harvesting in the 1980s. “If you take out all the trees in one shot and deplete the source of saponin, you are in deep shit in the future,” says Garo Armen, whose company, Agenus, helped bring QS-21 to market. Novavax has its own saponin-based adjuvant, called Matrix-M, and

www.cbrne-terrorism-newsletter.com 227 HZS C2BRNE DIARY – October 2020 warned investors last year that their vaccines could be delayed if they failed to “secure sufficient supplies” of high-quality extract. And the Hileys practically had a monopoly on it. During his call with the Hileys, Erck asked if Desert King could increase their production for Novavax a hundredfold. Paul Hiley’s jaw dropped to the table. Novavax was on the cusp of receiving $384 million in international funding to help it produce 100 million doses of its COVID-19 vaccine for the world by the end of the year, and a billion doses by the end of 2021. It would also soon be on the short list of vaccine candidates funded by the Trump administration’s Operation Warp Speed. Novavax needed guarantees of 1,500 pounds of saponin now, and up to three times as much next year. Hiley’s immediate concern was that his Chilean operation had already missed the bark-harvesting window—typically during the trees’ spring growth, between September and December. And last year he had made the ill-timed decision to postpone expanding their pharmaceutical operations in favor of investing in Desert King’s booming animal-feed business. In the end, Hiley knew there was only one way to answer Erck: “Of course, we can deliver it,” he said. Three months later, inside the Desert King conference room in early July, sitting across from a shelf displaying Slurpee cups and bottles of Stewart’s Root Beer, Hiley let out a chuckle through his surgical mask. “I had no idea if we could.” For all the talk about the cutting-edge vaccines that may just get us out of the COVID-19 mess, little has been written about adjuvants. Perhaps that shouldn’t be surprising: The late Yale professor Charles Janeway famously called adjuvants the “immunologist’s dirty little secret.” These unheralded helpers can turn a half-baked vaccine into an effective one, or stretch a scarce vaccine supply during a pandemic. Not every vaccine requires an adjuvant, but many do: Of the more than 200 vaccines listed in the Milken Institute’s COVID-19 vaccine tracker, approximately 40 percent are protein-based vaccines, which rarely work without an adjuvant. Yet adjuvants have never attracted much funding from industry and government. “Adjuvants have been the weak link in vaccines for the last hundred years,” says Nikolai Petrovsky, a vaccine researcher at Flinders University in Adelaide, Australia. The discovery of adjuvants is credited to a bearded veterinarian named Gaston Ramon, who worked at the Pasteur Institute in Paris in the 1920s. At the time, horses were routinely injected with toxins from tetanus and diphtheria so their bodies would produce antibodies that could be used in human therapies. Ramon, who was trying to develop the first human vaccines for these life- threatening diseases, observed that the horses’ circulating antibodies generally declined over time—even if the animals were re- injected with bacterial toxins every few weeks. Every so often, however, a new injection would cause waning antibody levels to rebound. When he examined the horses whose antibody levels rebounded, Ramon discovered abscesses at their injection sites. Those pus- filled lumps, he thought, could be temporarily trapping the toxins, giving the horses’ immune systems more time to ramp up their responses. Ramon experimented with ways of artificially slowing the absorption of the injected toxins, mixing them with bread crumbs, powdered infant formula, and tapioca starch—which happens to contain high levels of saponins—to produce local swelling without a full-blown abscess. One horse in his study, injected with a mix of toxins and tapioca, produced five times the normal levels of antibodies. Meanwhile, a British researcher found that aluminum salts, injected into guinea pigs, had similar but more predictable effects on antibody production. For the next 70 years, they would

www.cbrne-terrorism-newsletter.com 228 HZS C2BRNE DIARY – October 2020 be the only adjuvants used in vaccines. (While aluminum adjuvants can produce swelling and pain that lasts for a few days, abscesses and other side effects are uncommon.) The earliest viral vaccines actually did fine without adjuvants. The polio and measles vaccines were initially made from weakened or inactivated whole viruses, which were more than 90 percent effective after several doses. Both vaccine types generate an antibody response, and the live ones also activated another part of the immune system, the T-cell response, which is important for fighting more complex pathogens and can even kill the body’s own cells if they become infected. The risk of live-virus vaccines is that they can possibly revert to their more dangerous selves or replicate uncontrollably in people with weakened immune systems. Inactivated-whole-virus vaccines have also raised alarm after episodes where they altered the immune system in unpredictable ways. During a clinical trial in the 1960s, 31 infants received a vaccine made with inactivated respiratory syncytial virus (RSV). Those who later caught the virus ended up with a more severe form of the disease; two of the 23 who were infected died. By the early 1980s, the quest for ever-safer vaccines against ever-trickier viruses, such as RSV, hepatitis B, and HIV, led researchers to develop vaccines that contained just a fragment of the virus, typically a protein. But the immune system seemed blind to these new vaccines—until researchers added just the right adjuvant. Aluminum didn’t stimulate an appropriate T-cell response, which scientists noticed could be induced with other substances, such as heat-killed tuberculosis bacteria. “Why do we need to use adjuvants?” Janeway asked in 1989. “To be quite honest, the answer is not known.” Adjuvants posed their own dangers. During a pilot study of an adjuvanted flu vaccine in the 1990s, some subjects got triple-digit fevers and egg-shaped lumps on their arms. “That scared people,” says Tyler Martin, who once worked at the Chiron Corporation, which developed that vaccine. Adjuvants became a frequent target for the anti-vaccination community, which contributed to the FDA’s conservative approach to them. “At advisory-committee meetings, people come out to rail against adjuvants,” Peter Marks, the director of the FDA’s Center for Biologics Evaluation and Research, says. “We want to make sure they are safe.” In any event, the side effects were proof that adjuvants weren’t simply slowing down the spread of the antigen through the body. Perhaps, as Janeway himself theorized, they were flipping on some ancient danger switch to alert our immune system of an invader. In 1997, scientists located that switch: Our dendritic cells—the tentacled sentries lurking in our tissues—have at least 10 receptors attuned to pathogens. Some adjuvants act on those receptors. Martin, now the CEO of Adjuvance Technologies in Lincoln, Nebraska, told me, “Once we understand what’s the nature of the immune response we really want to create to COVID, then we can pick the right adjuvants to sculpt that response.” A couple of weeks after meeting the Hileys, I stood across the street from a Starbucks on the wooded edge of the University of California at Berkeley. It was 10 o’clock on a Wednesday morning in mid-July, but the place was uncannily quiet—all summer classes had moved online. During the previous week, the county had reported more than 1,000 new cases of COVID-19, the highest totals since the outbreak began. After a few minutes, a man rolled up on his bicycle, a buff cinched around his nose and mouth. Intense dark eyes peeked out from under his fluorescent-green helmet. This was Ricardo San Martin, a scientist who had helped develop the Chilean soapbark industry. He had moved on to other projects, but he still consulted for Desert King. In April, he said, he got a WhatsApp message from Damian Hiley that said simply: “Google Novavax.” When San Martin heard that Novavax was going to need several thousand pounds of Quillaja extract each year, he started doing the calculations in his head. Since 2000, Chile has cleared 11 percent of its native forests, and mature, accessible Quillaja saponaria trees have become rare. Under Chilean law, landowners need a special permit to cut down Quillaja trees, but they are allowed to prune up to 35 percent of their biomass every five years. Over the next few years, the industry was on course to exceed one published estimate of the maximum sustainable harvest of 27,000 tons, or about 67,500 trees. The Hileys say that number is a significant underestimate of what the forests can bear. Regardless, just one major vaccine rollout would require bark from the equivalent of 5,000 to 7,000 trees per year—or more if you’re only relying on prunings. San Martin realized that while most of the world was thinking about the pandemic’s risk to the human species, someone needed to be thinking about its antidote’s risk to Quillaja. “I feel like if I don’t do it,” he told me, “then who’s going to do it?” Keeping a safe distance from each other, San Martin and I walked around the perimeter of a small grove of trees just within the campus boundary, mostly eucalyptus and redwoods. We came to a tree about 60 feet tall with gray, sandpapery bark and waxy, oval-shaped leaves with rippled margins. This was it: a Chilean soapbark, one of a handful planted on the Berkeley campus starting in the late 1800s. San Martin—a chemical engineer, not a botanist—doesn’t know how they all ended up here, just that he’s lucky to live near them. (The soapbark is uncommon in the United States and tends to grow well only in California, which has a climate similar to Chile’s.)

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Pulling a pair of garden clippers out of a pannier on the side of his bike, he snipped off a few leafy branches to tuck inside a paper bag. Later, back in his garage laboratory a few blocks from campus, San Martin ground up the dried leaves and soaked them in warm water to produce an extract. As he shook the liquid up in a large graduated cylinder that looked like a theater prop, counting to 30, it produced a dense foam like the head of a beer. The amount of that foam, he explained, was roughly equivalent to the extract’s saponin content. Leaves aren’t currently used by industry because they represent just 5 percent of a mature tree’s weight. In a sapling, however, they may account for 30 to 50 percent of the tree’s biomass and are the only material that can be harvested sustainably. In the face of the current public-health emergency and the potentially life-saving role of saponin adjuvants, San Martin believes we should be establishing new soapbark-tree plantations inside and outside of Chile, and preparing to harvest leaves from the young trees. He’s now testing local soapbark stock inside Berkeley’s greenhouses, hunting for the plants best suited to found plantations on American soil. “What I want now, urgently, is to provide a second source of this natural raw material,” he said. He hopes to finish a mission he began long ago. Flash back to the early 1990s: Picture, if you will, San Martin sitting on the toilet. He was a newly minted Ph.D., working at the Catholic University in the Chilean capital of Santiago. He was looking for a project with commercial potential, something that might contribute to the Chilean economy as the country recovered from the cruelty and corruption of the Pinochet dictatorship. He had brought a copy of a United Nations newsletter into the bathroom, and one article caught his eye. It said that a “South American tree” was being tested in a vaccine against HIV. Only later did he realize that one of those very trees was growing in his own backyard. Chilean soapbarks were once abundant in the sun-soaked hills around the capital, climbing up the flanks of the Andes to about 6,000 feet. For hundreds, if not thousands, of years, the tree bark, ground up and mixed with water, was used as soap by the indigenous Mapuche people. In his 1782 treatise on the natural history of Chile, the Jesuit priest Juan Ignacio Molina wrote of its use by locals: “There is never to be seen on their clothes the least spot or dirt.” Over the next century, soapbark became an international commodity. American magazines offered up recipes for hair-curling liquids and wool detergents made with the soap-like saponins. Sozodont toothpaste advertised itself as “the only dentifrice” that contained “this salubrious botanical product.” (“When rosy lips part, pearls should glitter behind them.”) In the early 1900s, makers of carbonated beverages discovered that adding soapbark extract to their drinks created a coating of bubbles on the surface that kept the carbonation from escaping. From there, the applications of saponin expanded rapidly: During World War II, it was used in surveillance efforts as both a lens cleaner and an ingredient in photographic reagents. In 1949, a U.S. government report noted that careless bark-stripping methods were destroying “thousands of trees each year” and regulations were poorly enforced. Some harvesters simply peeled off the vital bark from around the main trunk, girdling the trees and leaving behind a slowly dying forest. Felling 25-year-old trees for about 35 pounds of bark was also wasteful: Up to 95 percent of their weight was being left to rot in the field. Landowners were paid just $30 for a tree’s worth of bark, which was then sent overseas for processing. Chile was destroying its natural heritage for a pittance, and when San Martin met with forestry experts, they asked if there was anything he could do to help. Back in his lab, San Martin began to study the chemical makeup of the tree’s fibers. Although saponins are most abundant in, and easiest to extract from, the bark, he found he could also obtain them from the trunk and the branches. Using this method, a single tree could replace five or six destroyed in the past. He also found that through judicious pruning, one could improve the condition of the scraggly stump-sprout trees left behind from previous clearcutting. San Martin hoped to develop a soapbark-processing industry in Chile, and he set out to find international buyers for saponin. With the help of a university loan, he started a company called Natural Response and spent several years hunting for customers—with little luck. With three kids to support, his bank account was shrinking, and interest on the loan was piling up. “I had one car from 1970-something with no brakes,” San Martin said. “I was bankrupted, honestly.” In 1995, one of San Martin’s employees sent a fax to Paul Hiley, whose business at that time revolved around saponins from Mexican yucca. Within days, Hiley was stepping off a plane in Chile. San Martin took him to the university to show him a small barrel of highly purified, powdered white saponin. “He was proud of his little production facility,” Hiley told me. But Hiley wasn’t interested in the high-grade stuff back then. He pointed at the cola-colored syrup that San Martin had yet to process. The crude extract was exactly what Hiley needed

www.cbrne-terrorism-newsletter.com 230 HZS C2BRNE DIARY – October 2020 for his clients in the soft-drink business. “I’ll buy 10 tons,” Hiley said. He purchased that first shipment and then wired San Martin an extra $300,000 to partner with him and expand the business. San Martin was still in a hole: He needed his extract to be a pure liquid, but it came out cloudy, filled with microscopic particles. Every attempt to refine it in the factory negated the cost-saving efficiencies he’d achieved in the field, and he wasn’t hitting the price targets he had promised Hiley. “I couldn’t say, ‘Paul, pay me 12, and you sell it at 11.’” In the late 1990s, while visiting his children in Montpellier, France, he stopped in a bookstore. He plucked a two-volume treatise on wine making off the shelf. “Why did I pull that out? I don’t know,” San Martin said. As he started reading, he realized that the food- safe processes that vintners used to remove clumps of tannin from their fermented grape juice could be applied to soapbark extract: “I rushed to Chile with that thing.” It was his Eureka moment. It was also his introduction to the Jevons paradox, the frustrating phenomenon by which technological increases in efficiency fuel increased demand. With San Martin’s innovations, the annual harvest of Quillaja declined from a high of 20,000 tons per year to around 5,000 tons. Then it started creeping up, exceeding 11,000 tons in 2012. The annual harvest is now approaching 20,000 tons again, according to Hiley. To some degree, this was San Martin’s own fault. He couldn’t stop inventing new applications for the soapy substance. He discovered that it could be used as a bio-pesticide for nematodes on grapes. (Saponins likely evolved as a defense against pests.) Then he found that it reduced the toxic mist of sulphuric acid that rises out of copper-extraction tanks. San Martin sold his remaining stake in the business to Hiley in 2005, and moved to Berkeley in 2013. Over the past 15 years, the fastest-growing part of Desert King’s business has been their saponin-based animal supplements, which can improve growth rates and reduce Salmonella infections in chickens. Desert King says its saponins, manufactured and sold by major feed companies, are now fed to more than 50 percent of antibiotic-free poultry in the U.S. The supplements are also showing promise in preventing infections of viruses and parasites in fish, including farmed salmon, a big business in Chile. Everyone at Desert King was enough of a believer in Quillaja’s juju that they began putting a few drops of extract into their coffee or orange juice each day to ward off disease. “It tastes like soap,” Damian Hiley told me. Whether this did anything for their health was doubtful, but the profits were undeniable: By the late 2000s, the company was bringing in tens of millions of dollars per year. Then, three years ago, the Food and Drug Administration gave QS-21 the nod of approval. “Everyone was knocking on our door,” Damian said. It is often said that vaccines are one of the most successful public-health interventions in human history. They are also bad business propositions. Two-thirds of vaccines fail in clinical trials. Once approved, they are often less profitable than drugs for cancer or rare diseases. In 2004, just five companies were manufacturing vaccines for Americans, down from 26 in 1967. Since then, vaccine makers have lost money trying to develop vaccines for Zika and Ebola, because the outbreaks subsided and government funding dried up. When the new coronavirus landed on U.S. shores, the major vaccine makers sat on the sidelines for weeks—a situation that Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, characterized as “very frustrating” during a February event at the Aspen Institute. Novavax, however, was the eager kid waving a hand in the back of the room. Founded in 1987, the company had so far failed to bring a vaccine to market, and stayed afloat through private investment, research contracts, and licensing deals. Last year, its clinical trial for an RSV vaccine was a bust. Tens of millions of dollars went down the drain, employees were laid off, and two development and manufacturing facilities were sold. Soul searching ensued. “If you get bad data, everybody thinks you’re a failure,” Gregory Glenn, the company’s president of R&D, says. “I have PTSD from that.” They got a gold star for attendance, though. Over the past decade, Glenn’s scientists have repeatedly pursued vaccines for emerging diseases including swine flu, Ebola, and Middle East respiratory syndrome, another coronavirus. Their laboratories maintained a stock of cells originally plucked from the ovaries of caterpillars in the 1970s. These cells were little factories that could be induced to pump out just about any kind of virus protein, including the coronavirus spike. Before Glenn joined Novavax in 2010, the company wasn’t a believer in adjuvants, arguing that an unadjuvanted flu vaccine would be faster to win FDA approval. But Glenn, a pediatrician who had worked in the laboratory of an adjuvant expert at the Walter Reed Army Institute of Research, thought it was time to embrace them. Adjuvants had undergone a renaissance, and QS-21 was its poster child. A crude saponin extract had been used in veterinary vaccines since the 1950s, but it was too toxic for humans, causing red blood cells to burst. In the 1990s, a researcher named Charlotte Kensil separated some of the 50 or so saponins in Quillaja saponaria extract, then tested them individually in mice. QS-7 was a potent adjuvant, but there wasn’t a lot of it. QS-18 proved to be the most toxic. QS-21 was relatively mild and generated both an antibody and a T-cell response.

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GlaxoSmithKline licensed QS-21 from the maker. In order to tune the immune response, it combined QS-21 with a second adjuvant, a fat-like substance derived from Salmonella bacteria. Three years ago, this potent combo came onto the market in their shingles vaccine, called Shingrix. “That vaccine hit the ball out of the park,” says Janet McElhaney, an expert on aging and immunity at Health Sciences North in Ontario. Shingrix conferred immunity on 91 percent of people over 70 years old, more than double that of a previous shingles vaccine. Last year, the same adjuvant combo was rolled out in parts of the world in GSK’s malaria vaccine, Mosquirix, and it is also a component of a late-stage-tuberculosis vaccine candidate. Novavax, meanwhile, obtained the rights to a different saponin-based adjuvant, now called Matrix-M, which was developed by a Swedish researcher who had worked on that HIV vaccine San Martin first read about. Recently, Novavax has tested Matrix-M as part of its NanoFlu vaccine, which not only provided a stronger antibody response than existing flu vaccines but also offered cross- protection against multiple strains of influenza. By the time COVID-19 arrived, the company was finishing up Phase 3 clinical trials of NanoFlu, which would demonstrate Matrix-M’s safety in 2,650 human subjects. In February, it began testing its COVID-19 vaccine with Matrix-M in animals, and the results coming out in the spring were promising. “We all need to be humble in front of trying to make a billion doses,” Glenn told me a couple of months ago. “But, so far, things have gone exceptionally well for us.” No matter how effective a COVID-19 vaccine is, it won’t put a dent in the pandemic unless it can be produced on a massive scale. The downside of an adjuvant is that it adds one more link to the global supply chain, one more crucial connection that can be broken. And by the time Novavax was preparing for its first human tests, the Hileys were struggling to keep their doors open. As COVID-19 started to circulate in the U.S., Desert King had to provide van transportation for its 220 Chilean workers to replace the public buses forced out of service due to pandemic restrictions. The company pulled strings with local officials for lockdown waivers, and solicited letters of support from Coca-Cola and GSK. By the middle of May, however, they no longer had enough employees coming to work to run their boilers, and they had to shut down. “Every company had the same sob story,” Damian Hiley said. “Maybe our messaging was falling on deaf ears.” The impending closure triggered a red alert at Novavax’s headquarters, some 5,000 miles away. The company sent an official letter to Chilean President Sebastián Piñera, requesting his assistance to help them put a halt to the pandemic. A couple of days later, Desert King got the exemption it needed and was cranking out Quillaja extract around the clock. It also resolved to break ground on a new pharmaceutical manufacturing suite. In July, Novavax made headlines with a $1.6 billion commitment from Operation Warp Speed, the largest award at the time. The Hileys knew that their harvesting practices in Chile were now under the global microscope. During my visit to Desert King’s headquarters, Damian showed a brand-new company video that included drone photos of vast stands of Quillaja, an upbeat soundtrack, and the soothing voice of a female narrator describing the company’s “sustainable objectives” and “responsible management.” “We hadn’t had to do this before,” he said of the public-relations campaign. “We really want to make sure that people understand, especially in Chile, that we are doing this in a responsible, sustainable, renewable, kosher, dotting-every-i-and-crossing-every-t way.” “I’m not an environmentalist by any stretch,” his father added. “As a capitalist, which I am, if I can make a buck, honestly, legally, and help people and not damage Mother Earth, well, check, check, check.” Desert King doesn’t own much land in Chile. Instead, they make agreements with local landowners. Their harvesters prune trees at intervals ranging from seven years to 20, using San Martin’s low-impact methods. They peel off all the bark they need for vaccines and use the rest of the tree biomass they harvest for their other businesses. They have mapped and tested thousands of trees to track their saponin makeup, which varies greatly by location. “Any fool can go to Chile and harvest a few trees,” Damian said. “The problem with QS-21 is that out of 100 trees, maybe five of them have the right profile.” As part of its long-term growth plan, Desert King gives out seedlings to Chilean landowners and encourages them to plant native Quillaja instead of exotic eucalyptus and pine. The country’s forestry managers have also distributed Quillaja seedlings around the country—139,000 last year, more than any other species. Five years ago, Desert King invested in a plantation specifically for their pharmaceutical contracts, using cloned trees high in QS-21. Those trees are now large enough for harvesting, but the company still has to ensure that the adjuvant produced from their extract will be equivalent in makeup and quality to what they were using before. Desert King plans to establish additional plantations in Chile, and possibly elsewhere, to match the needs of Novavax’s adjuvant, but any seedlings planted now will take years to produce harvestable bark—which is why San Martin’s work on Quillaja leaves is so critical. “Who knows what’s going to happen in Chile?” Damian said. “What if they say it’s illegal to harvest Quillaja?” The current supply is vulnerable in other ways: In January 2017, the country had the worst fires in its history, which burned more than a million acres of central-south Chile—a region home to Quillaja trees.

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Such concerns have provided an opening for Desert King’s competitors. Tyler Martin of Adjuvance Technologies told me that they can increase the adjuvant yield from a tree by a factor of a hundred, using its semisynthetic version of QS-21. Meanwhile, Agenus is now working with another company to grow QS-21 inside vats filled with cultured plant cells. Its partner, Phyton Biotech, used this method to wean the world off the Pacific yew, and is now the world’s largest supplier of paclitaxel. The other drugmakers partnering on a protein-subunit vaccine in Operation Warp Speed aren’t taking any chances with the saponin supply chain. GSK and Sanofi are using GSK’s less-potent oil-in-water adjuvant. It, too, contains a natural product—an oily compound from shark livers—but it is unlikely to face a supply constraint and has already been stockpiled. “That’s the way I would have gone,” Carl Alving, a retired Army adjuvant expert, says. “It’s much less expensive and much less difficult to formulate and put together in a very rapid period of time.” Damian Hiley brushes off the suggestion that the world shouldn’t rely on Quillaja for a COVID-19 vaccine. “That’s complete bullshit,” he said. “There’s plenty of material.” What his naysayers don’t realize, he said, is that San Martin recently revamped their process of extracting saponin from bark, allowing the company to double its efficiency. The company also believes Chile’s forests can sustain four times the current annual harvest. If supplies become tight and saponins are needed for multiple vaccines, they’d just shift production away from, say, chicken feed. “Maybe one day,” he said, “we’ll have to say to those customers, ‘Sorry, guys, we’re no longer supplying this.’” On August 4th, Novavax released the first data from its initial safety trials, which had tested the vaccine on 131 human subjects. The immune response was stellar, activating both antibody and T-cell production. “This is the first time I’m looking at something and saying, ‘Yeah, I’d take that,’” the Cornell virologist John Moore told The New York Times. As with other COVID-19 vaccines, some patients had experienced headaches, fatigue, and swelling at the injection site, but there were no serious side effects. Novavax’s protein-based vaccine will likely only arrive on the U.S. market after the faster-to-develop RNA vaccines from Moderna Therapeutics and Pfizer have received emergency approval. But unlike those gene-based vaccines, which require ultra-low- temperature freezers, protein-based vaccines can be stored in refrigerators, simplifying global distribution. Novavax has entered Phase 3 trials in the United Kingdom, while interim data from their Phase 2 trial in the U.S. is expected by the end of the year. Japan, Canada, South Korea, and the United Kingdom have now secured purchase agreements with Novavax, and the company expects to be able to produce 2 billion doses of vaccine annually in 2021. San Martin wants a safe, effective vaccine as much as anyone on Earth. While I was in Berkeley, he told me that two of his old friends from Chile had recently died from COVID-19. He and his wife had decided to temporarily increase their social-distancing measures. Six feet wasn’t far enough; he wanted 10. He is looking forward to being able to have a beer with friends, listen to live music, and talk about old times with Paul Hiley without wearing a mask. At times, the thought crosses his mind that he’s the only person who can save the trees in Chile. He brushes such anxious thoughts aside, though, because they prevent him from focusing on the science. As San Martin and I stood next to Berkeley’s soapbark trees, a groundskeeper rolled up behind us in a maintenance vehicle, a weed whacker and trash can in its bed. “What are we doing?” she hollered. San Martin spun around, a bouquet of leaves in his hand. “I’m taking a sample,” he said. “This tree has some compounds that are now being used in the best candidates for the COVID vaccine.” “Wow! That’s amazing,” the woman replied. “We’ll have to plant a lot of those, huh?” We took a moment to laugh, and to appreciate a brief social connection in dark times. The woman zoomed away. San Martin turned back to the tree with a serious look in his eyes. He craned his neck up toward the drooping branches overhead, then back at the promising leaves in his hand. “Okay,” he said. “So, here we go.”

Brendan Borrell is a Los Angeles–based writer. He is currently working on a book about the coronavirus-vaccine race.

COVID-19 Drug Shortages—and the Solutions By Lianna Matt McLernon Source: http://www.homelandsecuritynewswire.com/dr20201022-covid19-drug-shortages-and-the-solutions

Oct 22 – In the newest “COVID-19: The CIDRAP Viewpoint” report from the Center for Infectious Disease Research and Policy (CIDRAP), researchers lay out not only how the US drug supply chain has been vulnerable for years, but how those vulnerabilities are exacerbated by the COVID- 19 pandemic.

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To transform what the authors call a “fail and fix” approach to a “predict and prevent” paradigm, they offer nine specific recommendations that involve a more coordinated national policy framework to track, identify, mitigate, and prevent drug shortages using a transparent database of drug supply chains. This public database would encompass all prescription drug products in the US market, and analysis of the data would focus on the most critical drugs and the consequences that would likely be experienced if there is a shortage. Titled “Part 6: Ensuring a Resilient US Prescription Drug Supply,” the report points out that 29 (72.5 percent) of the 40 critical drugs for COVID-19 patients are experiencing shortages, according to the American Society of Health-System Pharmacists (ASHP). When these drugs are not available, healthcare providers have to consider rationing existing drug supplies, if any, finding therapeutic substitutes, or even having the patient go without treatment. “Our focus on drug supply chains started in 2018—well before this pandemic, and what we’re seeing fits right in,” CIDRAP Director Michael Osterholm, PhD, MPH, says, referencing the center’s Resilient Drug Supply Project (RDSP), for which he is co-principal investigator (PI). RDSP scientists produced today’s report. “At this point it’s fair to say that the pandemic is clearly showing the real challenges that the drug shortages represent,” Osterholm adds. CIDRAP publishes CIDRAP News, but its news operation functions independently from its research efforts.

Shortages to Continue Until Supply System Changes For some doctors, intubation-related drugs have become the rate-limiting factor for COVID-19 care, and not the ventilators or personal protective equipment (PPE, such as N95 respirators, surgical masks, and gowns) that grabbed headlines at the beginning of the pandemic. In the spring, for instance, orders for the heart medication norepinephrine spiked by 122 percent across the nation, with Premier reporting a 421 percent increase in New York, with the supplier able to fill only 55 percent of the orders. Shortages of this drug affect COVID-19 patients, but they also affect non–COVID-19 patients who have septic shock. A 2011 norepinephrine drug shortage led to a 3.7 percent increase of the in-hospital rate of death for patients with septic shock. A crucial drug cited in the report, propofol—a sedative to calm patients while they are intubated—has no close substitute, in part because of how quickly it can be adjusted to suit changes in the patient’s status. It, too, has been plagued by shortages. Another affected drug product has been albuterol inhalers. Their use for COVID-19 patients has created supply issues for patients using these inhalers for asthma or chronic obstructive pulmonary disease. Also, antibiotics such as azithromycin or the combination drug piperacillin-tazobactam have experienced shortages in the past few months. Whether local or nationwide, drug shortages relating to intubation, sedation, paralytics, pain, antivirals, antibiotics, and more affect not only COVID-19 patients but also those who need the same drugs for elective surgery or other reasons. “Last spring when we had a few states hitting their peak COVID-19 demand, the wholesalers and manufacturers were able to adjust by shipping supplies from the Midwest to the Northeast when New York and New Jersey needed it, or from the South to California and Washington,” says Stephen Schondelmeyer, PharmD, PhD, MPubAdm, senior author of the report and co-PI of the RDSP. “But when you have 30 to 35 states or more all hitting a peak at one point in time,” he adds, “there’s a much higher peak and really no place with excess drug supply to redistribute. Complicating the situation, the United States cannot expect to draw upon drug supplies from other parts of the world when most other countries are also facing increased need and demand due to COVID-19.”

Call for National Policy, New Entity To meet the demand, manufacturers have taken steps to ramp up production, and the FDA has adjusted its regulations, allowing some drugs to be made by compounding facilities, others to go to market with incomplete labels, and still other drugs to have extended expiration dates. These changes have helped, although they will not provide a complete or immediate fix. Changing drug production takes time and resources, and both are already stretched thin. COVID-19 outbreaks have led to factory production slowdowns and shutdowns, shipping disruptions, and export bans and barriers. Unexpected increases of drug production may take 2 or 3 months to a year rather than just a few weeks, as with PPE supplies. Schondelmeyer says, “Even though we can talk about the US demand and supply of drugs, when one works with the upstream drug supply chain, one quickly realizes that more than 70 percent of the drugs used in the United States are made outside of the country. So, we are actually dealing with a global drug supply chain.” Among the key recommendations in the report:

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❖ The United States should have a national process and infrastructure for analyzing, predicting, managing, and preventing shortages of critical medications. ❖ An in-depth map of the US drug supply chain is needed to identify where each drug product in the US market was made, including where the starting materials, active pharmaceutical ingredients, and finished drug product were produced. ❖ Congress should authorize and fund a national entity to build the map noted above, publish information on each drug’s supply chain, acquire and analyze prescription drug data, estimate the consequences of failing to address drug shortages, and coordinate national policy. ❖ This national entity could be an existing agency or a new federal start-up. ❖ Prescription drug profiles for each drug should be made publicly available on a consumer-friendly website and include key information.

Issues that Demand Response Unraveling the full journey of a drug product is one of the first steps to help people predict where supply is vulnerable and could break down. Right now, the RDSP is working to build a database that gathers, maps, and house such information. To truly prevent shortages, though, the “Viewpoint” recommendations align knowledge with action to create a national entity that proactively tracks the US drug supply and has the power to make sure supply needs are met. As Schondelmeyer puts it, “Traditional market forces may level out supply and demand in the long run, but when drug shortages occur, a patient who needs a life-saving drug now will not be able to wait for a long-run solution.” “These solutions aren’t going to happen overnight,” Osterholm says, “but hopefully this pandemic has provided a spotlight on a number of issues that demand response.”

Lianna Matt McLernon is a CIDRAP News staff writer.

Japan researchers show masks block coronavirus, but not perfectly Source [video]: https://www.japantimes.co.jp/news/2020/10/22/national/science-health/japan-masks-block-coronavirus/

Oct 22 – Japanese researchers have shown that masks can offer protection from airborne coronavirus particles, but even professional-grade coverings can’t eliminate contagion risk entirely. Scientists at the University of Tokyo built a secure chamber with mannequin heads facing each other. One head, fitted with a nebulizer, simulated coughing and expelled actual coronavirus particles. The other mimicked natural breathing, with a collection chamber for viruses coming through the airway. A cotton mask on the receiver head reduced its viral uptake by up to 40% compared with no mask. An N95 mask, used by medical professionals, blocked up to 90%. However, even when the

N95 was fitted to the face with tape, some virus particles still managed to get in. When a mask was attached to the coughing head, cotton and surgical masks blocked more than 50% of the virus transmission.

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“There was a synergistic effect when both the virus receiver and virus spreader wore masks,” the researchers wrote in a study published on Wednesday. There has been a growing consensus among health experts that the COVID-19 virus can be spread through the air. The U.S. Centers for Disease Control and Prevention (CDC) revised its guidance this month to say the pathogen can linger in the air for hours. A separate team of Japanese researchers used supercomputer simulations to show that humidity can have a significant effect on the airborne dispersion of virus particles.

EDITOR’S COMMENT: This and a few similar studies have proven the superiority of surgical/N95 face masks over cotton masks. End of story! So, why (all kind of) politicians keep on wearing cotton masks with these fancy logos and flags and all? And if they like them so much, why do not they issue a directive to sell 3-layers cotton masks only?

Microbial Forensics in Criminal Investigation Source: https://legaldesire.com/microbial-forensic/

Oct 22 – Many criminals, offenders often use biological material to cause crime and harm the victims in a group. But here Forensics come up with the new and growing techniques that are Microbial Forensics. Microbial forensics is the study of science for testing evidence from a bioterrorism act, bio crime, toxin release for attribution purposes by criminals in the form of microbes. Fungi, viruses, and bacteria are microorganism which is tested by microbial forensics. Bacteria, fungi, viruses all are eukaryotes and can cause disease in any living organism. In Bioterrorism criminal motives is to terrorize and make people worry about their health and in some cases murder them by using biological evidence. It has five phases that are preparedness, early warning, notification, response, and recovery. Many criminal organizations mostly terrorists and bio war scientists change little things in a virus or mutate it to make it toxic or lethal; insertions, deletions, and single nucleotide polymorphism are few techniques to cause changes. One such bio crime is white powder crime. Many microorganisms are altered by using techniques called genetic engineering. Scientists have discovered that modified microorganisms are resistant to many conditions like heat. Modified microorganisms also help in the production of food. They have been used in dairy, pharmaceutical, wine, beer etc. In 2001, The United States was under Anthrax caused by the bacteria Bacillus anthracis which almost killed 5 people of 22 who got anthrax. This bacteria in a powdered form were put into the letters. Also, anthrax spores can be easily released into the air and within a couple of minutes, thousands of people can get affected by inhaling contaminated air. In the year 1990s United States formed a unit called Hazardous Material Response Unit (HMRU) to investigate bioterrorism with scientific evidence. The Microbial Forensics field includes computer science, microbiology, phylogenetic, microbial genomes etc. The duty of microbial forensics is to identify the sample; collect the sample from the victims or sometimes from the crime scene, preserve the sample in a well proper way without causing any contamination and handle the sample in a well a mannered way. After lab analysis and they must provide the interpretation of tests with quality assurance. The microbial attack occurs in a group of people usually are of two types: covert way and overt way. In an overt way, it is caused by terrorist like for example transferring a package which contains biological agents and can harm people are released into the environment. In this case, there is a huge involvement of law enforcement and their concerns are who caused it, isolate identification, production process, and Epidemiologic concerns. Whereas in covert way attacks are natural disease break in an environment, for example, COVID 19. Public health administrators play a major role. They are usually concerned about the treatment process, how many people are infected, what is the causative agent, and the origin of the initial case. The term Validation is mostly used to signify reliance on a test or process, it is also important for scientific disciplines, like in the progressing field of microbial forensics. There is a minimal set of criteria that are supposed to be considered in evolving plans of validation of microbial forensics methods. A few of them are Description of scope, intended application, the purpose of the method, end results to be assessed, and so on. These criteria are applied to global goals, in the collection process, in transportation and storage under a chain of custody, in laboratory procedures, and an interpretation as well. It is not practicable for it to be all-inclusive due to the wide range of diversity of samples and their types for which microbial forensic methods are needed to be applied. Some of the application of microbial forensics in biological warfare is to trace outbreaks of microbial diseases, also many surveillances store the DNA fingerprints for microbes and maintain a database. Usually, the database contains all the information on biological and genetic data on the microbial disease. This data takes information from many organisms and compare one genome with another genome. In a crime aspect, microbial forensics can identify and give a clear explanation about the cause of death by any microorganisms. It also helps in finding the location by analyzing soil microbiomes and with sexually transmitted microbial diseases.

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Also, forensic scientists take help of microorganisms to identify the time of death by studying the bacteria cycle. During the decomposition of dead body, the microbes present on it have microbial succession and this succussion can help in finding the accurate time of death. During the unattended and suspicious criminal investigation ‘microbial clock’ is very helpful. Microbes are attached to body and biological conditions, so if in case the dead body is shifted to secondary crime scene, the microbes from primary crime scene can be found on the body. Its type of corroborative evidence leads crime investigator to primary crime scene. Microbes can also be found in lungs of victim, in case of drowning. Tools used by microbial forensics are electron microscopy, crystallography, molecular sequencing, microbial culture, chemistry, biochemistry, and mass spectrometry. Also, for finding causative agents lab should be sophisticated ventilated and scientists should wear Personal Protective Equipment (PPE) like gloves, masks, face shields, etc. Techniques used for finding infected agents as defined by the Sampling and Identification of Biological and Chemical Agents (SIBCA) handbook. It mainly has three techniques; firstly, it is Nucleic Acid Amplification Techniques, here microorganisms like Bacillus Anthrax, Brucella spp, Francisella tularensis, and Yersinia pestis re-identified by the Reverse transcription-polymerase chain reaction test (RT PCR). Due to the low number of bacteria samples, DNA dehydration, inappropriate DNA preparation lead to negative PCR results. Serology is the second technique used for the identification of microorganisms like Brucellosis, tularemia, and plague. This technique can give false-positive results due to the cross-reactions and can also give false negative due to extra or loss of antigenic structures. And lastly its Typing and Stain identification technique, here microbes are analyzed to see whether strains are from the same source or not. The result in this technique is obtained by Variable Number Tandem Repeat (VNTR), Multilocus Sequence Typing (MLST), Single Nucleotide Polymorphism (SNP), and other tools. Here the quality of the database is sometimes not reliable because it totally depended on the accuracy of submitted sequences.

Conclusion Microbial Forensics is still developing in India; it connects medicines with forensics. We need much research and awareness about bio crime and the future is also about bio war. Corona is one such example. With different tools and techniques, microbial forensics help in catching the perpetrators who cause bio crime and with advanced medical tools on microbial forensics help the medical to protect the people from biothreat.

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